Differentiation and diagnosis of benign and malignant testicular lesions using 18F-FDG PET/CT

ObjectivesThe purpose of this study was to evaluate the differential diagnostic value of ¹⁸F-fluorodeoxy glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for benign and malignant testicular lesions.MethodsThe PET/CT scans of 53 patients with testicular lesions confirmed by biopsy or surgical pathology were retrospectively analyzed. There were 32 cases of malignant tumors and 21 cases of benign lesions. Differences in the maximum standardized uptake value (SUVmax) measurements and the SUVmax lesion/background ratios between benign and malignant lesions were analyzed. The diagnostic value of this PET/CT modality for the differential diagnosis of benign versus malignant testicular lesions was calculated.ResultsThe differences in the SUVmax measurements and the SUVmax lesion/background ratios between benign and malignant lesions were statistically significant (SUVmax: Z = −4.295, p = 0.000; SUVmax lesion/background ratio: Z = −5.219, p = 0.000); specifically, both of these indicators were higher in malignant lesions compared to benign lesions. An SUVmax of 3.75 was the optimal cutoff value to differentiate between benign and malignant testicular lesions. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this PET/CT modality in the differential diagnosis of benign versus malignant testicular lesions were 90.6%, 80.9%, 86.8%, 87.9%, and 85.0%, respectively.Conclusions¹⁸F-FDG PET/CT can accurately identify benign and malignant testicular lesions.     

F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer

ObjectiveWe evaluated the prognostic impact of quantitative assessment by maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG) on [F-18] FDG PET/CT for patients with peritoneal carcinomatosis from epithelial ovarian cancer (EOC).MethodsThirty-one patients with EOC underwent PET/CT for an early restaging after cytoreductive surgery, having been diagnosed with carcinomatosis (before chemotherapy). The SUVmax, MTV (cm³; 42% threshold) and TLG (g) were registered on residual peritoneal lesions. The patients were followed up 20 ± 12 months thereafter. The PET/CT results were compared to overall survival (OS).ResultsThe Kaplan-Meier survival analysis for the SUVmax did not reveal significant differences in OS (p = 0.48). The MTV survival analysis showed a significant higher OS in patients presenting with a higher tumour burden than those with less tumour burden (p = 0.01; 26 vs. 14 months), whereas TLG exhibited a similar trend though not significant (p = 0.06). Apart from chemo-resistance, the higher the MTV, the better will be the response to chemotherapy.ConclusionsQuantitative assessment by MTV rather than by SUVmax and TLG on PET/CT may be helpful for stratifying patients who present with peritoneal carcinomatosis from EOC, in order to implement the appropriate therapeutic regimen.     

A comparative analysis of dual-phase dual-energy CT and FDG-PET/CT for the prediction of histopathological invasiveness of non-small cell lung cancer

PurposeTo compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs).Materials and methodsWe selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44–85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using “syngo Dual Energy Lung Nodules” application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis.ResultsThe A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p = 0.011, p = 0.021, and p = 0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p = 0.020) but not with lymphatic permeation or vascular invasion (p = 0.088 and p = 0.100, respectively). In the subgroup of patients with lesion diameters ≤2 cm, the A/D ratio was significantly correlated with locoregional invasiveness (p = 0.040), while the SUVmax was not (p = 0.121).ConclusionFor the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.     

Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma

PurposeTo investigate the relationships between pretreatment volume-based quantitative ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters and overall survival (OS) in patients with malignant pleural mesothelioma (MPM).Materials and methodsWe retrospectively reviewed data from 201 MPM patients, of whom 38 underwent surgical resection, and calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), including primary tumors and nodal or distant metastatic lesions, on pretreatment ¹⁸F-FDG PET/CT. Relationships between clinicopathological factors (age, sex, performance status, European Organization for Research and Treatment of Cancer [EORTC] score, histological subtype, TNM stage, and treatment strategy), volume-based quantitative PET/CT parameters, and OS were evaluated using a Cox proportional hazards model and log-rank test.ResultsThe median follow-up was 15 months (range, 1–96 months; median, 17 months). In a univariate analysis of all patients, older age (p < 0.05), high EORTC score (p < 0.001), non-epithelioid histological subtype (p < 0.001), high T stage (p < 0.001), positive N/M status (p < 0.05, p < 0.001), advanced TNM stage (p < 0.001), non-surgical treatment (p < 0.001), and high SUVmax (p < 0.001), MTV (p < 0.001), or TLG (p < 0.001) were associated with significantly shorter OS. A multivariate analysis confirmed non-epithelioid subtype (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.14–2.48; p < 0.05), non-surgical treatment (HR: 0.58, 95% CI: 0.34–0.95; p < 0.05), and high TLG (HR: 1.97, 95% CI: 1.14–3.44; p < 0.05) as independent negative predictors.ConclusionsPretreatment volume-based quantitative ¹⁸F-FDG PET/CT parameters, especially TLG, could serve as potential surrogate markers for MPM prognosis.     

18F-FDG PET/CT and contrast-enhanced CT findings of pulmonary cryptococcosis

PurposePulmonary cryptococcosis is an uncommon cause of pulmonary nodules in non-AIDS patients. This study reports the ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET/CT) and contrast-enhanced CT (CE-CT) findings of 42 patients with pulmonary cryptococcosis.Materials and methodsA retrospective review of the ¹⁸F-FDG PET/CT and CE-CT findings of 42 patients with histologically proven pulmonary cryptococcosis was conducted. All patients underwent PET/CT and CE-CT in the same session. The CT diagnosis was based on the location, morphological features, and enhancement of lesions. The PET/CT findings were recorded, and clinical data and surgical and histopathological findings were collected.ResultsThe results of the PET scans revealed that 37 (88%) of 42 patients showed higher FDG uptake, and 5 (12%) patients demonstrated lower FDG uptake than the mediastinal blood pool. The maximum standardized uptake value (SUV) of pulmonary cryptococcosis ranged from 1.4 to 13.0 (average: 5.7 ± 3.3, median 4.9). A single nodular pattern was the most prevalent pattern observed and was found in 29 (69%) patients. This pattern was followed by scattered nodular (n = 4, 10%), clustered nodular (n = 3, 7%), mass-like (n = 3, 7%), and bronchopneumonic (n = 3, 7%) patterns. The most frequent pattern of immunocompetent patients was the single nodular pattern (29 of 33, 88%). Immunocompromised patients most frequently pattern exhibited mass-like (3 of 9, 33%) and bronchopneumonic (3 of 9, 33%) patterns.ConclusionPulmonary cryptococcosis most commonly appears as single nodules in immunocompetent patients. Mass-like and bronchopneumonic patterns were common in immunocompromised patients. In 88% of patients, lung lesions showed high FDG uptake, thus mimicking a possible malignant condition.     

Correlations between the iodine concentrations from dual energy computed tomography and molecular markers Ki-67 and HIF-1α in rectal cancer: A preliminary study

PurposeTo investigate whether dual energy computed tomography (CT) with iodine quantification is correlated with molecular markers Ki-67and hypoxia-inducible factor 1α (HIF-1α)in rectal cancer (RC).Materials and methodsEighty patients (43 males and 37 females) diagnosed with rectal cancer got pelvic contrast-enhanced CT scan with dual energy computed tomography before any anticancer treatment. Analyse the normalized iodine concentration (NIC) values and CT values at each energy level (40–140 keV) from the virtual monochromatic image of the primary lesions. The postoperative specimens of all 80 patients underwent Ki-67 and HIF-1α immunohistochemistry staining. By SPSS17.0 software package, we analyzed the correlations of NIC values and CT values at each energy level (40–140 keV) with Ki-67 and HIF-1α expression. The receiver operating characteristic (ROC) curves of these dual energy computed tomography parameters were calculated and the diagnostic value were assessed.ResultsThere was a weak positive correlation between NIC values and carcinoembryonic antigen level (r = 0.246, P = 0.028) in RC. Both the value and the level of Ki-67 expression were correlated positively with the NIC values (r = 0.344, P = 0.002 and r = 0.248, P = 0.026). HIF-1α expression was correlated positively with the NIC values of the RC (r = 0.598, P < 0.001). The best threshold values of NIC values in diagnosing the expression of HIF-1α was 0.5839. The sensitivity, 78%; specificity, 87%; PPV, 86%; NPV,79%;accuracy, 83%.ConclusionThe NIC values on dual energy computed tomography may be used as a measurement of hypoxia in RC and determining the ability of tumor invasion noninvasively.     

Influence of free fatty acids on glucose uptake in prostate cancer cells

IntroductionThe study focuses on the interaction between glucose and free fatty acids (FFA) in malignant human prostate cancer cell lines by an in vitro observation of uptake of fluoro-2-deoxy-d-glucose (FDG) and acetate.MethodsHuman prostate cancer cell lines (PC3, CWR22Rv1, LNCaP, and DU145) were incubated for 2 h and 24 h in glucose-containing (5.5 mM) Dulbecco’s Modified Eagle’s Medium (DMEM) with varying concentrations of the free fatty acid palmitate (0–1.0 mM). Then the cells were incubated with [¹⁸ F]-FDG (1 μCi/mL; 0.037 MBq/mL) in DMEM either in presence or absence of glucose and in presence of varying concentrations of palmitate for 1 h. Standardized procedures regarding cell counting and measuring for ¹⁸ F radioactivity were applied. Cell uptake studies with ¹⁴C-1-acetate under the same conditions were performed on PC3 cells.ResultsIn glucose containing media there was significantly increased FDG uptake after 24 h incubation in all cell lines, except DU145, when upper physiological levels of palmitate were added. A 4-fold increase of FDG uptake in PC3 cells (15.11% vs. 3.94%/10⁶ cells) was observed in media with 1.0 mM palmitate compared to media with no palmitate. The same tendency was observed in PC3 and CWR22Rv1 cells after 2 h incubation. In glucose-free media no significant differences in FDG uptake after 24 h incubation were observed. The significant differences after 2 h incubation all pointed in the direction of increased FDG uptake when palmitate was added. Acetate uptake in PC3 cells was significantly lower when palmitate was added in glucose-free DMEM. No clear tendency when comparing FDG or acetate uptake in the same media at different time points of incubation was observed.ConclusionsOur results indicate a FFA dependent metabolic boost/switch of glucose uptake in PCa, with patterns reflecting the true heterogeneity of the disease.     

Role of 18F-FDG PET/CT in differentiation of a benign lesion and metastasis on the ribs of cancer patients

ObjectiveIncidental 18-Fluoro-2-deoxyglucose positron emission tomography (¹⁸F-FDG) uptake in the ribs is a relatively common finding on positron emission tomography/computed tomography (PET/CT) images of cancer patients. This study examined the role of ¹⁸F-FDG PET/CT in differentiating between benign lesions and metastases on the ribs.MethodsThis study included 264 lesions in 172 PET/CT cases with underlying malignancy showing newly developed indeterminate ¹⁸F-FDG rib uptake between June 2009 and May 2010. Patients with more than five FDG rib uptakes or hematologic malignancy were excluded. Malignancy was confirmed either histologically or by imaging studies, and clinical follow-up with serial images was at least 6 months. The maximum standardized uptake value (SUVmax) of the rib lesion was recorded. The FDG uptake patterns (focal or segmental; discrete or non-discrete) and CT findings (evidence of fracture, soft tissue lesions, osteoblastic and/or osteolytic lesions) were recorded.ResultsThere were 206 benign lesions and 58 metastases. The SUVmax was significantly higher in the metastatic group (3.0±1.8) than in the benign group (2.5±1.1), (P= .014). For the differential diagnosis between benign and metastatic lesions, the best SUVmax cut-off was determined to be 2.4. Significant indicators for metastasis were a segmental FDG uptake pattern (OR=10.262, 95% CI 4.151–25.371), presence of an osteoblastic/-lytic lesion (OR=22.903, 95% CI 10.468 to 50.108) and the absence of fractures on CT (OR=291.629, 95% CI 39.09–2175.666).ConclusionSUVmax alone is not sufficient to differentiate benign and metastatic rib lesions in cancer patients. The diagnostic accuracy can be further increased when findings of the CT part of PET/CT are considered.     

Short term heat acclimation reduces heat strain during a first,but not second,consecutive exercise-heat exposure

ObjectivesDetermine whether five days of heat acclimation reduces cardiovascular and thermoregulatory strain during consecutive exercise-heat exposures on the sixth day in the heat.DesignPair-matched randomized control trial.MethodsTwenty-four males completed two, 120 min exercise sessions (Session 1, Session 2) in a single day before (Day 1) and after (Day 6) four additional days of exercise in either hot (HOT: 40 °C, 40% relative humidity, n = 16) or temperate (CON: 23 °C, 25% relative humidity, n = 8) environments. A mixed-methods heat acclimation approach was implemented. Day 2 consisted of 120 min of moderate-high intensity treadmill exercise. Days 3–5 consisted of 90 min of moderate-high intensity exercise, with HOT completing this in a hyperthermia clamped manner at rectal temperature ≥38.5 °C, and CON < 38.5 °C.ResultsSession 1 end of exercise rectal temperature and heart rate were lower on Day 6 compared to Day 1 for HOT (p = 0.012, p = 0.003) but not CON (p = 0.152, p = 0.437). Session 2 end of exercise rectal temperature was not different between days for HOT (p = 0.104) or CON (p = 0.275). Session 2 end of exercise heart rate was lower on Day 6 compared to Day 1 for HOT (p = 0.004) and CON (p = 0.039). Session 1 sweat sensitivity was greater on Day 6 compared to Day 1 for HOT (p = 0.039) but not CON (p = 0.257). Sweat rate was unchanged for HOT and CON between days during Session 1 (p = 0.184, p = 0.962) and Session 2 (p = 0.051, p = 0.793), respectively.ConclusionsFive days of heat acclimation reduced cardiovascular strain but not thermoregulatory strain during the second, consecutive exercise-heat exposure.ClinicalTrials.gov IdentifierNCT04053465.     

Correlation between enhancement characteristics of MR mammography and capillary density of breast lesions

ObjectiveTo correlate capillary density of breast lesions using the markers D2-40, CD31, and CD34 with early and late enhancement of magnetic resonance mammography (MRM).Materials and methodsThe local ethics committee approved this study, and informed consent was available from all patients. The study included 64 women with 66 histologically proven breast lesions (41 malignant, 25 benign). MR-enhancement 1 min after contrast medium administration was determined in the tumor (I_t1/I_t0 ratio) and in comparison to the surrounding tissue (I_t1/I_t1-fat ratio). Capillary density was quantified based on immunohistological staining with D2-40, CD31, and CD34 in breast tumors and surrounding breast tissue. Mean capillary densities were correlated with contrast enhancement in the tumor and surrounding breast tissue. The Kruskal–Wallis test was used to test whether lesions with different MR enhancement patterns differed in terms of capillary density.ResultsFor CD34, there was statistically significant correlation between capillary density and tumor enhancement (r = 0.329, p = 0.012), however not for the malignant or benign groups separately. Mean vessel number identified by staining with D2-40 and CD31 did not correlate significantly with tumor enhancement (D2-40: r = −0.188, p = 0.130; CD31: r = 0.095, p = 0.448). There were no statistically significant differences in capillary density between breast lesions with delayed enhancement or a plateau and lesions showing washout (Kruskal–Wallis test. D2-40: p = 0.173; CD31: p = 0.647; CD34: p = 0.515).ConclusionOf the three markers tested, CD34 showed best correlation between early contrast enhancement on MRM and capillary density. Further studies are necessary to clearly demonstrate an association between capillary density and contrast enhancement in breast tumors and surrounding tissue.     

Adrenergic pathway activation enhances brown adipose tissue metabolism: A [18 F]FDG PET/CT study in mice

ObjectivePharmacologic approaches to study brown adipocyte activation in vivo with a potential of being translational to humans are desired. The aim of this study was to examine pre- and postsynaptic targeting of adrenergic system for enhancing brown adipose tissue (BAT) metabolism quantifiable by [¹⁸ F]fluoro-2-deoxyglucose ([¹⁸ F]FDG) positron emission tomography (PET)/computed tomography (CT) in mice.MethodsA β₃-adrenoreceptor selective agonist (CL 316243), an adenylyl cyclase enzyme activator (forskolin) and a potent blocker of presynaptic norepinephrine transporter (atomoxetine), were injected through the tail vein of Swiss Webster mice 30 minutes before intravenous (iv) administration of [¹⁸ F]FDG. The mice were placed on the PET/CT bed for 30 min PET acquisition followed by 10 min CT acquisition for attenuation correction and anatomical delineation of PET images.ResultsActivated interscapular (IBAT), cervical, periaortic and intercostal BAT were observed in 3-dimentional analysis of [¹⁸ F]FDG PET images. CL 316243 increased the total [¹⁸ F]FDG standard uptake value (SUV) of IBAT 5-fold greater compared to that in placebo-treated mice. It also increased the [¹⁸ F]FDG SUV of white adipose tissue (2.4-fold), and muscle (2.7-fold), as compared to the control. There was no significant difference in heart, brain, spleen and liver uptakes between groups. Forskolin increased [¹⁸ F]FDG SUV of IBAT 1.9-fold greater than that in placebo-treated mice. It also increased the [¹⁸ F]FDG SUV of white adipose tissue (2.2-fold) and heart (5.4-fold) compared to control. There was no significant difference in muscle, brain, spleen, and liver uptakes between groups. Atomoxetine increased [¹⁸ F]FDG SUV of IBAT 1.7-fold greater than that in placebo-treated mice. There were no significant differences in all other organs compared to placebo-treated mice except liver (1.6 fold increase). A positive correlation between SUV levels of IBAT and CT Hounsfield unit (HU) (R² = 0.55, p < 0.001) and between CT HU levels of IBAT and liver (R² = 0.69, p < 0.006) was observed.ConclusionsThe three pharmacologic approaches reported here enhanced BAT metabolism by targeting different sites in adrenergic system as measured by [¹⁸ F]FDG PET/CT.     

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions

ObjectivesTo investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI).MethodsIn this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0 × 0.9 × 2.5 mm, temporal resolution 4.32 s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied.ResultsTTE had a significantly better discriminative ability than curve type (p < 0.001 and p = 0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p = 0.549 and p = 0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p < 0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ = 0.86) and substantial for conventional assessment (κ = 0.75).ConclusionsTTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high accuracy.     

Longitudinal observation of [11C]4DST uptake in turpentine-induced inflammatory tissue

IntroductionLongitudinal changes of 4′-[methyl-¹¹C]thiothymidine ([¹¹C]4DST) uptake were evaluated in turpentine-induced inflammation.MethodsTurpentine (0.1 ml) was injected intramuscularly into the right hind leg of male Wistar rats. Longitudinal [¹¹C]4DST uptake was evaluated by the tissue dissection method at 1, 2, 4, 7, and 14 days after turpentine injection (n = 5). The tumor selectivity index was calculated using the previously published biodistribution data in C6 glioma-bearing rats. Dynamic PET scan was performed on day 4 when maximum [¹¹C]4DST uptake was observed during the longitudinal study. Histopathological analysis and Ki-67 immunostaining were also performed.ResultsThe uptake of [¹¹C]4DST in inflammatory tissue was significantly increased on days 2–4 after turpentine injection, and then decreased. On day 14, tracer uptake returned to the day 1 level. The maximum SUV of inflamed muscle was 0.6 and was 3 times higher than that of the contralateral healthy muscle on days 2–4 after turpentine injection. However, tumor selectivity index remains very high (> 10) because of the low inflammation uptake. A dynamic PET scan showed that the radioactivity in inflammatory tissues peaked at 5 min after [¹¹C]4DST injection, and then washed out until 20 min. At intervals > 20 min, radioactivity levels were constant and double that of healthy muscle. The changes in Ki-67 index were paralleled with those of [¹¹C]4DST uptake, indicating cell proliferation-dependent uptake of [¹¹C]4DST in inflammatory tissues.ConclusionIn our animal model, low but significant levels of [¹¹C]4DST uptake were observed in subacute inflammation.     

Nutrient intake,meal timing and sleep in elite male Australian football players

ObjectivesTo investigate the relationship between dietary intake, meal timing and sleep in elite male Australian football players.DesignProspective cohort study.MethodsSleep and dietary intake were assessed in 36 elite male Australian Football League (AFL) players for 10 consecutive days in pre-season. Sleep was examined using wrist activity monitors and sleep diaries. Dietary intake was analysed using the smartphone application MealLogger and FoodWorks. Generalised linear mixed models examined the associations between diet [total daily and evening (>6 pm) energy, protein, carbohydrate, sugar and fat intake] and sleep [total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO) and sleep onset latency (SOL)].ResultsTotal daily energy intake (MJ) was associated with a longer WASO [β = 3, 95%CI: 0.2–5; p = 0.03] and SOL [β = 5, 95%CI: 1?9; p = 0.01]. Total daily protein intake (g kg^?1) was associated with longer WASO [β = 4, 95%CI: 0.8?7; p = 0.01] and reduced SE [β = ?0.7 CI: ?1.3 to ?0.2; p = 0.006], while evening protein intake (g kg^?1) was associated with shortened SOL [β = ?2, 95%CI: ?4 to ?0.4), p = 0.02]. Evening sugar intake (g kg^?1) was associated with shorter TST [β = ?5, 95%CI: ?10 to ?0.6; p = 0.03] and WASO [β = ?1, 95%CI: ?2 to ?0.3; p = 0.005]. A longer period between the evening meal consumption and bedtime was associated with a shorter TST [β = ?8, 95%CI: ?16 to ?0.3; p = 0.04].ConclusionsEvening dietary factors, including sugar and protein intake, had the greatest association with sleep in elite male AFL players. Future research manipulating these dietary variables to determine cause and effect relationships, could guide dietary recommendations to improve sleep in athletes.     

T1 mapping cardiovascular magnetic resonance imaging to detect myocarditis—Impact of slice orientation on the diagnostic performance

BackgroundT1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations.MethodsThis study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5 T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15 min after administration of 0.075 mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) −BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH).ResultsThere were significantly lower native T1 values on 3LAX (1081 ms (1037–1131 ms)) compared to 3SAX (1107 ms (1069–1143 ms), p = 0.0022) in patients with myocarditis, but not in controls (1026 ms (1009–1059 ms) vs. 1039 ms (1023–1055 ms), p = 0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (p < 0.0001) on 3SAX, 0.85 (p < 0.0001) on 1SAX, 0.76 (p = 0.0002) on 3LAX, 0.70 (p = 0.0075) on 4CH, 0.72 (p = 0.0020) on 3CH and 0.75 (p = 0.0003) on 2CH. The AUCs for ECV-BOPTA were 0.83 (p < 0.0001) on 3 SAX, 0.82 (p < 0.0001) on 1SAX, 0.77 (p = 0.0005) on 3LAX, 0.71 (p = 0.0079) on 4CH, 0.69 (p = 0.0371) on 3CH and 0.75 (p = 0.0006) on 2CH.ConclusionNative T1 and ECV-BOPTA on short axes slices provide a better diagnostic performance in myocarditis than long axes slices since long axes slices seem to underestimate native myocardial T1 in myocarditis. T1 mapping in suspected myocarditis can be restricted to a single mid-ventricular short-axis slice without a significant loss in diagnostic performance.     

A cross-sectional comparison between cardiorespiratory fitness,level of lesion and red blood cell distribution width in adults with chronic spinal cord injury

ObjectivesTo assess; (1) differences in red blood cell distribution width between individuals with chronic (>1 year), motor-complete cervical (n = 21), upper-thoracic (n = 27) and thoracolumbar (n = 15) spinal cord injury and, (2) associations between red blood cell distribution width and cardiorespiratory fitness.DesignProspective multi-center, cross-sectional study.MethodsPeak oxygen uptake was determined using an upper-body arm-crank exercise test to volitional exhaustion and red blood cell distribution width was measured using an automated hematology system.ResultsThere were significant (p < 0.009) differences between groups classified by level of injury in absolute and relative peak oxygen uptake, peak power output and red blood cell distribution width. A significant (p < 0.001) large negative association (r = −0.524) was found between relative peak oxygen uptake and red blood cell distribution width. Unbiased recursive partitioning, while revealing study site specific differences in red blood cell distribution width, identified homogenous subgroups based specifically on cardiorespiratory fitness irrespective of additional demographic and injury characteristics.ConclusionThe strong negative association between cardiorespiratory fitness and red blood cell distribution width in individuals with paraplegia parallel those previously observed in non-disabled individuals. Higher red blood cell distribution width values are an independent risk factor for increased cardiovascular mortality, heart failure, and coronary heart disease and may reflect several underlying exacerbated metabolic responses such as oxidative stress and systemic inflammation. These data emphasize the importance of maintaining a high aerobic capacity following spinal cord injury.     

Effect of 5-aminolevulinic acid photodynamic therapy on keratinocyte proliferation and apoptosis in condyloma acuminatum

BackgroundThe effect of 5-aminolevulinic acid photodynamic therapy on keratinocyte proliferation and apoptosis in condyloma acuminatum tissues was evaluated.MethodsAn immunohistochemical method and TdT-mediated dUTP nick end labeling were performed to detect the positive expression of the keratinocyte proliferation-related gene Ki-67 and apoptosis, respectively, in condyloma acuminatum tissues.ResultsOf 52 cases, 44 showed positive expression of Ki-67 in condyloma acuminatum keratinocytes before the treatment, with a positive expression rate of 84.62% (44/52), an expression strength of mostly ++ − +++, and a Ki-67 proliferation index of 80.26 ± 5.07%. After treatment, 22 cases showed positive expression of Ki-67 in condyloma acuminatum keratinocytes, with a positive expression rate of 42.31% (22/52), an expression strength of mostly − − ++, and a proliferation index of 42.67 ± 3.06%. The differences in the positive expression rate, expression strength, and proliferation index in the before- and after-treatment groups were statistically significant (χ² = 20.070, P < 0.001). For visible apoptotic cells in condyloma acuminatum keratinocytes before the 5-aminolevulinic acid photodynamic treatment, the expression strength was mostly + − ++, and the average apoptotic index was 13.94 ± 2.35%; after treatment, the expression strength was mostly ++ − +++, and the average apoptotic index was 73.88 ± 7.65%; the difference in the apoptotic index between the before and after treatment groups was statistically significant (P < 0.001).Conclusion5-Aminolevulinic acid photodynamic therapy can inhibit the proliferation and promote the apoptosis of keratinocytes, and represents an effective mechanism for treating condyloma acuminatum.     

Variability of gait,bilateral coordination,and asymmetry in women with fibromyalgia

PurposeTo analyze how fibromyalgia affected the variability, asymmetry, and bilateral coordination of gait walking at comfortable and fast speeds.Methods65 fibromyalgia (FM) patients and 50 healthy women were analyzed. Gait analysis was performed using an instrumented walkway (GAITRite system). Average walking speed, coefficient of variation (CV) of stride length, swing time, and step width data were obtained and bilateral coordination and gait asymmetry were analyzed.ResultsFM patients presented significantly lower speeds than the healthy group. FM patients obtained significantly higher values of CV_StrideLength (p = 0.04; p < 0.001), CV_SwingTime (p < 0.001; p < 0.001), CV_StepWidth (p = 0.004; p < 0.001), phase coordination index (p = 0.01; p = 0.03), and p_CV (p < 0.001; p = 0.001) than the control group, walking at comfortable or fast speeds. Gait asymmetry only showed significant differences in the fast condition.ConclusionFM patients walked more slowly and presented a greater variability of gait and worse bilateral coordination than healthy subjects. Gait asymmetry only showed differences in the fast condition. The variability and the bilateral coordination were particularly affected by FM in women. Therefore, variability and bilateral coordination of gait could be analyzed to complement the gait evaluation of FM patients.     

The value of paradoxical uptake of hepatocellular carcinoma on the hepatobiliary phase of gadoxetic acid-enhanced liver magnetic resonance imaging for the prediction of lipiodol uptake after transcatheter arterial chemoembolization

PurposeTo compare the response to transcatheter arterial chemoembolization (TACE) between hepatocellular carcinoma (HCC) with paradoxical uptake on the hepatobiliary phase (HBP) (HCC_para) and HCC with defect on the HBP (HCC_def), and to identify some imaging features that can differentiate between two groups.Materials and methodsNinety-three HCCs from 54 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) prior to TACE were included. HCCs were classified into two groups according to the signal intensity (SI) on the HBP: HCC_para and HCC_def. Using post-TACE computed tomography (CT) as a reference standard, initial compact lipiodol uptake was assessed and compared between groups. The arterial enhancement ratio (AER), SI ratios of the arterial phase and HBP, and presence of the capsule appearance were compared between groups. After initial response, local tumor recurrence within 6 and 18 months was evaluated based on follow-up CT or MRI.ResultsFifteen HCC_para and 78 HCC_def were included. Compared to HCC_def, HCC_para showed more frequent initial compact lipiodol uptake (p = 0.009), larger mean size (p = 0.019), lower AER (p = 0.005), higher SI ratio of the HBP (p < 0.0001), and more frequent capsule appearance (p < 0.0001). Local tumor recurrence rate within 6 months was also significantly lower in HCC_para than in HCC_def (p = 0.008).ConclusionDespite larger size and lower AER, HCC_para showed more frequent initial compact lipiodol uptake and lower early local recurrence rate after TACE than did HCC_def.     

Prognostic value of 3′-Deoxy-3′-18F-Fluorothymidine ([18F] FLT PET) in patients with recurrent malignant gliomas

Introduction3′-deoxy-3′-18F-fluorothymidine ([¹⁸F] FLT) PET has been proven to be of value in diagnosis and assessment of glioma grading, in differentiating tumor recurrence from necrosis, in response assessment and in predicting overall survival (OS) in the primary high grade glioma. In this study, we evaluated the value of [¹⁸F] FLT PET-CT in predicting the OS of patients with recurrent malignant glioma.MethodsFifty-six patients with recurrent malignant glioma were enrolled in this prospective study. The PET-CT and contrast-enhanced MRI scans were performed in all patients. Tumor volume was determined from both PET image (proliferative volume, PV) and MRI image (Vol-MRI). Patients were followed up clinically until death. The likelihood of using PET-derived parameters of SUV_max, tumor-to-normal (T/N) ratio, and PV to predict the OS of patients were assessed in comparison with Vol-MRI and other clinical parameters.ResultThe follow up periods for all patients ranged from 1.5 to 35.6 months with median of 9.8 months. Univariate analysis showed that the following parameters were significantly correlated with OS: grade of primary tumor (p = 0.042), Karnofsky performance score (KPS) (p = 0.041), T/N ratio (p < 0.01), Vol-MRI (p = 0.041), and PV (p < 0.001). However, multivariate Cox regression showed that only the PV (p < 0.001) and T/N ratio (p = 0.001) were independent predictors. The thresholds to predict OS were 16.88 cm³ for PV and 10.94 for T/N ratio. Kaplan–Meier analyses using these thresholds showed a significant discrimination between short and long OS groups (p < 0.001).ConclusionThe PV and T/N ratio of tumor on [¹⁸F] FLT PET-CT are independent predictors of survival in patients with recurrent malignant glioma. The PV on [¹⁸F] FLT PET seems to be more predictive than tumor volume on T1-weighted MRI for OS.