Comparison of urine results concerning co-consumption of illicit heroin and other drugs in heroin and methadone maintenance programs

Urine samples of patients from a heroin maintenance program (HMP) and a methadone maintenance program (MMP) were chromatographically analyzed 1 month before and 6 and 12 months into treatment for the presence of classical markers of heroin use as well as for the presence of markers for illicit heroin abuse. Furthermore, the samples were immunochemically tested for cannabinoids, cocaine metabolites, amphetamine, methylendioxyamphetamines and benzodiazepines. A co-consumption of illicit heroin (HER) in the HMP was determined to be 50% but was significantly lower compared to the MMP with a co-use of 71%. The incidence was high because not only acetylcodeine (AC) as a very specific marker was considered but also other marker substances for illicit HER use. Amphetamines played only a minor part in both collectives, and the proportion of HER and methadone patients using cocaine was similar and decreased during treatment. Also, the benzodiazepine use decreased, and cannabis use was high in both collectives during treatment. Considering only the AC in the present study, a co-use of illicit HER in the HMP was similar to previous reports concerning HER-assisted treatment programs. If additional marker substances were examined, the suspicion of a co-use of illicit HER is markedly enhanced.     

Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles

Objective Several measures can quantify thoracic kyphosis from radiographs, yet their suitability for people with osteoporosis remains uncertain. The aim of this study was to examine the validity and reliability of the vertebral centroid and Cobb angles in people with osteoporosis. Design and patients Lateral radiographs of the thoracic spine were captured in 31 elderly women with osteoporosis. Thoracic kyphosis was measured globally (T1–T12) and regionally (T4–T9) using Cobb and vertebral centroid angles. Multisegmental curvature was also measured by fitting polynomial functions to the thoracic curvature profile. Canonical and Pearson correlations were used to examine correspondence; agreement between measures was examined with linear regression. Results Moderate to high intra- and inter-rater reliability was achieved (SEM = 0.9–4.0°). Concurrent validity of the simple measures was established against multisegmental curvature (r = 0.88–0.98). Strong association was observed between the Cobb and centroid angles globally (r = 0.84) and regionally (r = 0.83). Correspondence between measures was moderate for the Cobb method r = 0.72), yet stronger for the centroid method (r = 0.80). The Cobb angle was 20% greater for regional measures due to the influence of endplate tilt. Conclusions Regional Cobb and centroid angles are valid and reliable measures of thoracic kyphosis in people with osteoporosis. However, the Cobb angle is biased by endplate tilt, suggesting that the centroid angle is more appropriate for this population.     

Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study

Background  Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. Methods and results  One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, ^99mTc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 ± 54 versus 125 ± 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 ± 211 versus 286 ± 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 ± 15 versus 14 ± 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17–8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38–8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10–12.25, p < 0.01) were independent predictors of an infarct size > 12%. Conclusions  Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size.     

Fluid-fluid levels in bone neoplasms: variation of T1-weighted signal intensity of the superior to inferior layers—diagnostic significance on magnetic resonance imaging

The diagnostic relevance of the relative T1-weighted (T1W) and T2-weighted (T2W)/short tau inversion recovery (STIR) MRI signal intensity characteristics of the superior to inferior fluid layers within fluid-fluid levels (FFLs) found in bone tumours was investigated. A retrospective analysis was performed of MRI studies of 2,568 patients presenting with a suspected bone tumour over an 8-year period. Final diagnosis was made by biopsy/surgical resection or characteristic imaging/clinical findings. Subjects were divided by the absence/presence of FFLs and benign/malignant histology. Cases with FFLs were sub-categorised by the relative signal intensity of the superior/inferior layer as high/low or low/high on T1W and T2W/STIR sequences. Out of the total of 2,568 cases, 214 (8.3%, CI 7.3–9.5%) had FFLs and 2,354 (91.7%, CI 90.5–92.7%) had no FFLs. All 214 cases with FFLs had T2W/STIR sequences available, all demonstrating high/low signal intensity characteristics; 135/214 (63.1%, CI 56.2–69.6%) were benign and 79/214 (36.9%, CI 30.4–43.8%) were malignant. Out of the 214 patients, 151 had T1W sequences performed; 52 showed high/low signal intensity, of which 30 (57.7%, CI 34.2–71.3%) were benign and 22 (42.3%, CI 28.7–56.8%) were malignant (P = 0.06 compared with no FFL group); 50 showed low/high signal intensity, of which 40 (80%, CI 66.3–90.0%) were benign and ten (20%, CI 10.0–33.7%) were malignant (P = 0.0000, compared with the no FFL group). The low/high and high/low groups had a significantly greater proportion of benign and malignant lesions, respectively (P = 0.015). In conclusion, all FFLs showed high/low signal intensity characteristics on T2W/STIR sequences. Low/high signal on T1W was significantly associated with benign disease. Malignancy may occur slightly more frequently with high/low signal on T1W.     

Disposition of ketamine and norketamine in hair after a single dose

As a rapid-acting dissociative anesthetic, ketamine has been used in drug-facilitated crimes. The aim of this study is to investigate the disposition of ketamine and its main metabolite norketamine in hair after a single dose of ketamine. Four healthy volunteers were recruited into the study. Hair was collected 1, 2, 3, 4, 8, 12 and 16 weeks after a single oral dose of ketamine solution (10 mg) and analyzed by liquid chromatography/electrospray ionization tandem mass spectrometry. The wet cotton swab wiped the scalp of the subjects at 1 h, 24 h, 48 h and 1 week after administration. Maximum hair concentrations (C _max) for ketamine and norketamine were 19.0 ± 6.5 and 18.7 ± 13.3 pg/mg, respectively. Except for the first week, the ratio of ketamine to norketamine in most of segments (87.5%) was greater than 1. All the cotton swab samples collected at 24 and 48 h were positive. The results from cotton swabs and the concentrations of ketamine and norketamine in hair segments collected at different times showed that some of ketamine and norketamine incorporated into hair originated from sweat and sebum on the scalp of the subjects.     

High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [_95%CI = 1.3–119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [_95%CI = 2.2–82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [_95%CI = 1.2–32.1], p = 0.0002) or ESR (OR = 8.8 [_95%CI = 1.5–50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD.     

Emergency MRI of acute pelvic pain: MR protocol with no oral contrast

The aim of this study was to evaluate the efficacy of magnetic resonance (MR) without oral contrast in the assessment of suspected acute pathologies of the pelvis in pregnant and non-pregnant patients. Sixty-seven patients who had MR of the lower abdomen and pelvis for acute abdomen were included in the study. The MR examinations were evaluated for indication of the study, type of MR sequences, and sensitivity of MR in diagnosing the disease. T2 single shot fast spin echo (SS-FSE), T2 FSE, short tau inversion recovery, pre-gadolinium T1, and post-gadolinium T1 sequences were utilized. There were 30 pregnant and two postpartum women in the study group. Positive pelvic MR findings were seen in 73% (49/67). Final diagnoses were acute appendicitis (n = 12), ovarian torsion (n = 6), abscess (n = 3), tubo-ovarian abscess (n = 2), ovarian tumor (n = 2), degenerating fibroid (n = 3), and perianal fistula (n = 2). For acute appendicitis, sensitivity was 100% (12/12), and positive predictive value was 92% (12/13). Post-gadolinium T1-weighted sequences and T2 SS-FSE with FS were the sequences, which were most likely to best demonstrate the acute appendicitis. For ovarian torsion, the sensitivity was 86% (6/7), and positive predictive value was 100% (6/6). MR imaging is an efficacious means of diagnosing acute appendicitis, ovarian torsions, and other adnexal diseases in the acute setting. The four sequence protocol without oral contrast offers an excellent means of investigating the cause of acute lower abdominal and pelvic pain.     

Detection and quantification of synthetic cathinones and selected piperazines in hair by LC-MS/MS

New psychoactive substances (NPS)—such as synthetic cathinones and piperazines—are defined as substances designed to replicate the effects of traditional illegal drugs, including cocaine, ecstasy and amphetamines. These substances are known to potentially be much more potent than their analogs. In the past, there were many poisonings and deaths associated with NPS. Because of this, NPS identification and quantification have become more important in forensic toxicology. The present work aimed to develop, validate and apply a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method capable of detecting 35 synthetic cathinones and piperazines in hair samples. All target analytes were resolved in a 12 min run time and identified based on the quantifier ion, at least one product ion and the retention time. Depending on the analyte, the calibration curves were linear over a maximal range of 0.01–3 ng/mg. The limits of detection and quantification were within the ranges of 0.006–0.052 ng/mg and 0.008–0.095 ng/mg, respectively. The precision, bias and matrix effect were all within acceptable GTFCh thresholds and the method was free from interferences. The validated method was successfully used to identify synthetic cathinones and piperazines in authentic hair samples (n = 40) from forensic cases, demonstrating its suitability for the screening and quantification of a wide number of new stimulants in hair specimens.     

Non-specific interstitial pneumonia in cigarette smokers: a CT study

The goal of this study was to seek indirect evidence that smoking is an aetiological factor in some patients with non-specific interstitial pneumonia (NSIP). Ten current and eight ex-smokers with NSIP were compared to controls including 137 current smokers with no known interstitial lung disease and 11 non-smokers with NSIP. Prevalence and extent of emphysema in 18 smokers with NSIP were compared with subjects meeting GOLD criteria for chronic obstructive pulmonary disease (COPD; group A; n = 34) and healthy smokers (normal FEV₁; group B; n = 103), respectively. Emphysema was present in 14/18 (77.8%) smokers with NSIP. Emphysema did not differ in prevalence between NSIP patients and group A controls (25/34, 73.5%), but was strikingly more prevalent in NSIP patients than in group B controls (18/103, 17.5%, P < 0.0005). On multiple logistic regression, the likelihood of emphysema increased when NSIP was present (OR = 18.8; 95% CI = 5.3–66.3; P < 0.0005) and with increasing age (OR = 1.04; 95% CI = 0.99–1.11; P = 0.08). Emphysema is as prevalent in smokers with NSIP as in smokers with COPD, and is strikingly more prevalent in these two groups than in healthy smoking controls. The association between NSIP and emphysema provides indirect support for a smoking pathogenesis hypothesis in some NSIP patients.     

Synthesis and in vivo evaluation of a novel 5-HT1A receptor agonist radioligand [O-methyl- 11C]2-(4-(4-(2-methoxyphenyl)piperazin-1-yl)butyl)-4-methyl-1,2,4-triazine-3,5(2H,4H)dione in nonhuman primates

Purpose Serotonin_1A (5-HT_1A) receptors exist in high- and low-affinity states, and agonist ligands bind preferentially to the high-affinity state of the receptor and provide a measure of functional 5-HT_1A receptors. Although the antagonist tracers are established PET ligands in clinical studies, a successful 5-HT_1A receptor agonist radiotracer in living brain has not been reported. [¹¹C]MPT, our first-generation agonist radiotracer, shows in vivo specificity in baboons; however, its utility is limited owing to slow washout and immeasurable plasma free fraction. Hence we performed structure-activity relationship studies of MPT to optimize a radiotracer that will permit valid quantification of 5-HT_1A receptor binding. We now report the synthesis and evaluation of [¹¹C]MMP as an agonist PET tracer for 5-HT_1A receptors in baboons. Methods In vitro binding assays were performed in bovine hippocampal membranes and membranes of CHO cells expressing 5-HT_1A receptors. [¹¹C] labeling of MMP was performed by reacting desmethyl-MMP with [¹¹C]CH₃OTf. In vivo studies were performed in baboons, and blocking studies were conducted by pretreatment with 5-HT_1A receptor ligands WAY-100635 and (±)-8-OH-DPAT. Results MMP is a selective 5-HT_1A receptor agonist (K _i 0.15 nM). Radiosynthesis of [¹¹C]MMP was achieved in 30 ± 5% (n = 15) yield at EOS with a specific activity of 2,600 ± 500 Ci/mmol (n = 12). PET studies in baboons demonstrated specific binding of [¹¹C]MMP to 5-HT_1A receptor-enriched brain regions, as confirmed by blockade with WAY-100635 and (±)-8-OH-DPAT. Conclusion We identified [¹¹C]MMP as an optimal agonist PET tracer that shows quantifiable, specific binding in vivo to 5-HT_1A receptors in baboons.     

Fast T2 mapping of the patellar articular cartilage with gradient and spin-echo magnetic resonance imaging at 1.5 T: validation and initial clinical experience in patients with osteoarthritis

Objective To evaluate the T2 mapping of patellar articular cartilage in patients with osteoarthritis using gradient and spin-echo (GRASE) magnetic resonance (MR) imaging. Materials and methods After the imaging of a phantom consisting of two sealed 50-ml test objects with different concentrations (30% and 90% weight/volume) of copper sulphate, the T2 mapping of patellar articular cartilage was performed in 35 patients (21 male and 14 female; mean age ± SD 42 ± 17 years) with moderate degree of patellar osteoarthritis. Turbo-spin-echo (TSE) (TR milliseconds/minimum–maximum TE milliseconds 3,000/15–120; total acquisition time 5 min 52 s) and GRASE (TR milliseconds/minimum–maximum TE milliseconds 3,000/15–120; total acquisition time 1 min 51 s) were employed. In each patient patellar cartilage was segmented at nine locations (three superior, three central, and three inferior) by manually defined regions of interest. T2 relaxation times were calculated using a linear fit applied to the logarithm of signal intensity decay. Results In the phantom the T2 values measured by GRASE were similar to those measured by MR spectroscopy (test object 1: 48.1 ms vs 51 ms; test object 2: 66.8 ms vs 71 ms; P > 0.05, Wilcoxon test). In patients GRASE and TSE-derived T2 values demonstrated good agreement (mean difference ± SD, 1.81 ± 3.63 ms). The within-patient coefficient of variation was 22% for TSE and 23% for GRASE. Conclusion Fast T2 mapping of the patellar articular cartilage can be performed with GRASE within a third of the time of that of standard sequences. This study was performed thanks to the support of a private grant, “Arduino Ratti”, provided through the Italian Society of Medical Radiology.     

Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience

To prospectively evaluate the long-term clinical safety and efficacy of a newly designed self-expanding metallic stent (SEMS) in the treatment of patients with achalasia. Seventy-five patients with achalasia were treated with a temporary SEMS with a 30-mm diameter. The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4–5 days after stent placement. Follow-up data focused on dysphagia score, technique and clinical success, clinical remissions and failures, and complications and was performed at 6 months, 1 year, and within 3 to 5 years, 5 to 8 years, 8 to 10 years, and >10 years postoperatively. Stent placement was technically successful in all patients. Complications included stent migration (n = 4, 5.33%), chest pain (n = 28, 38.7%), reflux (n = 15, 20%), and bleeding (n = 9, 12%). No perforation or 30-day mortality occurred. Clinical success was achieved in all patients 1 month after stent removal. The overall remission rates at 6 months, 1, 1–3, 3–5, 5–8, 8–10, and >10 year follow-up periods were 100%, 96%, 93.9%, 90.9%, 100%, 100%, and 83.3%, respectively. Stent treatment failed in six patients, and the overall remission rate in our series was 92%. The median and mean primary patencies were 2.8 ± 0.28 years (95% CI: 2.25–3.35) and 4.28 ± 0.40 years (95% CI: 3.51–5.05), respectively. The use of temporary SEMSs with 30-mm diameter proved to be a safe and effective approach for managing achalasia with a long-term satisfactory clinical remission rate. Supported by the National Key Medical Research and Development Program of China during the 9th Five-year Plan Period (no. 96–907–03–04), Shanghai Nature Science Funds (no. 02Z1314073), Shanghai Medical Development Funds (no. 00419), the National Natural Science Foundation of China (no. 30670614).     

Mapping of liver fat with triple-echo gradient echo imaging: validation against 3.0-T proton MR spectroscopy

The purpose of this study was to validate a magnetic resonance imaging (MRI) technique for mapping liver fat, using ¹H magnetic resonance spectroscopy (¹H-MRS) as the reference standard. In 91 patients with type 2 diabetes, 3.0-T single-voxel point-resolved ¹H-MRS was used to calculate the liver fat fraction (LFF) from the water (4.76 ppm) and methylene (1.33 ppm) peaks, corrected for T1 and T2 decays. LFF (corrected for T1 and T2* decays) was also obtained from the mean signal intensity on a map built from a triple-echo (consecutive in-phase, opposed-phase, and in-phase echo times) breath-hold gradient echo sequence, using basic image calculation functions (arithmetic mean, subtraction, division, multiplication by a numerical factor). Mean LFF was 8.9% (range, 0.9–33.5) by MRI and 8.8% (range, 0–34.1) by ¹H-MRS. Pearson’s coefficient was 0.976 (P < 0.0001) and Lin’s coefficient was 0.975 (P < 0.0001). Liver segment had no significant influence. With Bland–Altman analysis, 95.6% (87/91) of data points were within the limits of agreement. Given its excellent agreement with ¹H-MRS, our mapping technique can be used for visual and quantitative evaluation of liver fat in everyday practice.     

Computer-assisted detection of pulmonary embolism: performance evaluation in consensus with experienced and inexperienced chest radiologists

The value of a computer-aided detection tool (CAD) as second reader in combination with experienced and inexperienced radiologists for the diagnosis of acute pulmonary embolism (PE) was assessed prospectively. Computed tomographic angiography (CTA) scans (64 × 0.6 mm collimation; 61.4 mm/rot table feed) of 56 patients (31 women, 34–89 years, mean = 66 years) with suspected PE were analysed by two experienced (R1, R2) and two inexperienced (R3, R4) radiologists for the presence and distribution of emboli using a five-point confidence rating, and by CAD. Informed consent was obtained from all patients. Results were compared with an independent reference standard. Inter-observer agreement was calculated by kappa, confidence assessed by ROC analysis. A total of 1,116 emboli [within mediastinal (n = 72), lobar (n = 133), segmental (n = 465) and subsegmental arteries (n = 455)] were included. CAD detected 343 emboli (sensitivity = 30.74%, correct-positive rate = 6.13/patient; false-positive rate = 4.1/patient). Inter-observer agreement was good (R1, R2: κ = 0.84, 95% CI = 0.81–0.87; R3, R4: κ = 0.79, 95% CI = 0.76–0.81). Extended inter-observer agreement was higher in mediastinal and lobar than in segmental and subsegmental arteries (κ = 0.84–0.86 and κ = 0.51–0.58 for mediastinal/lobar and segmental/subsegmental arteries, respectively P < 0.05). Agreement between experienced and inexperienced readers was improved by CAD (κ = 0.60–0.62 and κ = 0.69–0.72 before and after CAD consensus, respectively P < 0.05). The experienced outperformed the inexperienced readers (Az = 0.95, 0.93, 0.89 and 0.86 for R1–4, respectively, P < 0.05). CAD significantly improved overall performances of readers 3 and 4 (Az = 0.86 for R3, R4 and Az = 0.89 for R3, R4 with CAD, P < 0.05), by enhancing sensitivities in segmental/subsegmental arteries. CAD improved experienced readers’ sensitivities in segmental/subsegmental arteries (sens. = 0.93 and 0.90 for R1, R2 before and 0.97 and 0.94 for R1, R2 after CAD consensus, P < 0.05), without significant improvement of their overall performances (P > 0.05). Particularly inexperienced readers benefit from consensus with CAD data, greatly improving detection of segmental and subsegmental emboli. This system is advocated as a second reader.     

Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction

The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events (MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR] 95% confidence interval [CI]: 3.6 [1.8–7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1–6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1–5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3–7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1–23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95% CI]: 2.5 [1.0–6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6–21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic impact of PMO might be superior to MO.     

Concentrations of Δ9-tetrahydrocannabinol,cocaine and 6-monoacetylmorphine in hair of drug abusers

Hair samples taken from 850 individuals with presumed drug abuse were tested simultaneously forΔ⁹tetrahydrocannabinol (THC), cocaine, heroin, the primary heroin metabolite 6-monoacetylmorphine (6-MAM) and morphine. The drugs were extracted with methanol under sonication. Compared to other extraction procedures this solvent extraction technique provides high extraction yields and less experimental effort. The analyses were carried out using gas chromatography - mass spectrometry (GCMS) in selected ion monitoring (SIM) mode. This procedure allows the simultaneous detection of amphetamine, methylenedioxyamphetamine (MDA), methylenedioxymetbamphetamine (MDMA) and methylenedioxyethylamphetamine (MDE). THC was found in 104 (12.2%), cocaine in 230 (27%) and 6-MAM in 141 (16.6%) samples. In addition to 6-MAM, morphine was detected in 87 (10.2%) and heroin in 38 samples (4.5%). The concentrations found were in a range 0.009-16.7 ng/mg for THC, 0.037-129.68 ng/mg for cocaine, 0.028-79.82 ng/mg for 6-MAM, 0.045-53.14 ng/mg for heroin and 0.011-7.800 ng/mg for morphine. The statistical distribution of the drug concentrations compared with the self-reported consumption behaviour of the users may possibly lead to a better understanding of the relationship between drug dosage and corresponding concentrations in hair.     

Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria

The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 ± 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84–100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51–100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 ± 0.035 (R1) and 0.74 ± 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy

The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7–75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1–4); mean applied laser energy 33 kJ (range 15.3–94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5–7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases.     

No advantage of time-of-flight magnetic resonance angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms

Introduction  Long-term follow-up after coil embolization of intracranial aneurysms is mandatory to monitor coil compacting and aneurysm recurrence. Most centers perform one digital subtraction angiography (DSA) on follow-up continuing with time-of-flight magnetic resonance angiography (TOF–MRA). This study explores the diagnostic value of TOF–MRA at 1.5 T versus 3 T compared to DSA. Materials and methods  In 18 patients with 20 aneurysms treated with coil embolization, TOF–MRA at 1.5 and 3 T were performed the day before follow-up DSA, the latter serving as reference. Optimized diagnostic protocols were applied (1.5 T: 0.78 × 0.55 × 0.8 mm, voxel size; acquisition time (TA), 6.37 min; 3 T: 0.56 × 0.45 × 0.65 mm, voxel size; TA, 3.12 min). Three independent neuroradiologists experienced in neuroendovascular therapy rated the occlusion rate (“complete occlusion” vs. “residual neck” vs. “residual aneurysm”) and compared the two methods subjectively. Weighted κ statistics were calculated to assess the level of interobserver agreement. Results  Compared to DSA, TOF–MRA was more sensitive in detecting neck remnants, with a slight advantage at 3 T. Regarding artifact load, there are advantages at 1.5 T. Ratings of the occlusion rate correlated highly between all observers (r > 0.85, p < 0.001, respectively). Interobserver agreement was high in all cases (к _w ≈ 0.8, respectively). Conclusion  TOF–MRA is a reliable tool for follow-up imaging of cerebral aneurysms after endovascular treatment. Our study shows no advantage of TOF–MRA at 3 T over 1.5 T, when comparable measurement protocols are applied. TOF–MRA at 1.5 T therefore provides appropriate information regarding a therapeutic decision.     

Radiofrequency ablation of high-grade dysplastic nodules in chronic liver disease: comparison with well-differentiated hepatocellular carcinoma based on long-term results

This retrospective study compared the long-term results of percutaneous radiofrequency (RF) ablation for high-grade dysplastic nodules (DNs) and well-differentiated hepatocellular carcinomas (HCCs). Between April 1999 and December 2006, 20 patients with 21 high-grade DNs (range, 1.2–3.0 cm; mean, 1.9 cm) (group 1) and 49 with a well-differentiated HCC (range, 1.0–5.0 cm; mean, 2.3 cm) (group 2) underwent RF ablation. The technique effectiveness, local tumor progression, cancer-free and cumulative survivals using the Kaplan-Meier method were compared. The technique effectiveness rates at 1 year after RF ablation were 100% (19/19) and 94.1% (32/34) in groups 1 and 2, respectively (P > 0.05). The local tumor progression rates in groups 1 and 2 were 0% and 20.6% (7/34), respectively (P = 0.041). The local tumor progression in group 2 was seen on follow-up computed tomography 4–58 months (mean, 17 months) after RF ablation. The 1-, 3-, and 5-year cancer-free survival rates in groups 1 and 2 were 95.0% and 76.9%, 56.2% and 44.6%, and 38.5% and 24.8%, respectively (P > 0.05). The 1-, 3-, and 5-year cumulative survival rates in groups 1 and 2 were 100% and 97.9%, 73.0% and 68.0%, and 63.8% and 51.1%, respectively (P > 0.05). Percutaneous RF ablation is effective for treating high-grade DNs and well-differentiated HCCs. The long-term results after RF ablation of high-grade DNs may be improved compared with those of well-differentiated HCCs.