Imaging with positive T(1) -contrast using superstimulated echoes

This article presents the basic principles of the superstimulated echo mechanism and shows preliminary results of its application to T₁‐weighted imaging with positive T₁‐contrast. A superstimulated echo scheme uses a preparation of square‐wave modulated, periodically inverted z‐magnetization, which after signal evolution during the mixing time TM is fully converted into transverse magnetization. This avoids the 50% signal loss of a conventional stimulated echo. Furthermore, its implementation as a preparation module for standard turbo spin echo (TSE) imaging allows producing images with positive T₁‐contrast. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

Sonographic localization of hematomas in hemophilic patients with positive iliopsoas sign

Sonography was performed on 23 hemophilic patients presenting with positive iliopsoas sign. In 21 of these patients sonography confirmed the presence of hematomas. Comparison of the presumed clinical location and the sonographic location, however, revealed a significant discrepancy. Only seven of 15 hematomas that were clinically suspected to be in the iliopsoas muscle were confirmed by sonography at that location. Of the remaining cases, three were localized in the hip joint, one in the proximal thigh, one in the abdominal wall, and one in the iliac fossa. Hemorrhage was not found in two cases. This study indicates that sonography provides valuable information about the site of hematoma in these patients.     

Octreotide scans are positive in a subset of patients with hepatocellular carcinoma

PURPOSE: In vitro data suggest that a proportion of hepatocellular carcinomas express the somatostatin receptor. However, in vivo data are lacking. There has been little reported use of octreotide scans in hepatocellular carcinomas. This study was performed to determine the percentage of positive results of octreotide scanning in patients with hepatocellular carcinoma. MATERIALS AND METHODS: In-111 octreotide scans were performed in the standard manner in eight patients with unresectable hepatocellular carcinoma. Computer fusion imaging of the nuclear medicine and computed tomographic scans was performed in selected patients. RESULTS: Five of eight (63%) patients tested had hepatocellular carcinomas that displayed focal tracer uptake. CONCLUSIONS: This is the first report of positive uptake of octreotide scans in patients with hepatocellular carcinoma. These findings may have implications for the treatment of hepatocellular carcinoma with octreotide. Furthermore, these results may broaden the differential diagnosis in patients with positive results of octreotide scanning.     

Routine use of FDG-PET scans in melanoma patients with positive sentinel node biopsy

Purpose Positron emission tomography (PET) scanning is an efficient and well-known diagnostic tool in various malignant disorders. However, the utility of PET as a clinical routine screening procedure for the detection of subclinical metastases in stage III melanoma patients has not yet been established.Methods Thirty-three patients with cutaneous malignant melanoma and subclinical lymph node metastases diagnosed by sentinel node biopsy (SNB) were submitted to ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) whole-body PET scanning within 100 days after SNB and wide local excision. Before PET scanning, patients were screened conventionally and found to be without evidence of further dissemination. Positive PET scan findings were evaluated by computed tomography scanning, magnetic resonance imaging and ultrasonography. Biopsy was performed whenever possible. The median follow-up was 15 months (range 6–39 months).Results Nine patients (27%) had a positive PET scan performed after SNB and WLE. On verification, four cases (12%) were found to be true positive for melanoma metastasis and were thus upgraded from stage III to stage IV. Furthermore, one patient (3%) had another primary malignancy (prostate carcinoma), and two (6%) were found to have non-malignant lesions. Two PET-positive patients (6%) refused further investigations. In one case (3%) the PET scan was false negative. Twenty-three (69%) PET scans were true negative.Conclusion In a number of stage III melanoma patients with positive SNB, postoperative whole-body FDG-PET scanning revealed further melanoma dissemination not found by conventional screening methods and thus identified these cases as stage IV. Relevant therapy can accordingly be instituted earlier on the basis of FDG-PET scanning.Statement: We have no financial sponsorship. This study has been executed in a public hospital, and we have full control of all primary data. We agree to allow the EJNMMI to review our data if requested.     

梅毒血清试验阳性的女性不孕症分析

目的探讨梅毒血清试验阳性对女性不孕症患者妊娠和胎儿的影响。方法分析在我院生殖中心就诊的女性不孕症患者的临床资料,随访梅毒血清试验阳性者妊娠及新生儿情况。结果梅毒血清试验阳性者139例(1.38%),RPR阳性/TPPA阴性35例;RPR阴性/TPPA阳性11例;RPR与TPPA均阳性93例。经驱梅治疗后,RPR阳性/TPPA阴性23例;RPR阴性/TPPA阳性7例;RPR与TPPA均阳性4例。74例患者通过辅助生殖成功怀孕,69例分娩出正常新生儿,5例在孕期。结论女性不孕症患者梅毒血清试验阳性率较高;梅毒血清试验阳性的女性不孕症者,通过规范驱梅或试验性治疗后,可进行辅助生殖且与梅毒血清试验阴性患者分娩的新生儿无明显差异。     

Tumoral calcinosis associated with sarcoidosis and positive bone and gallium imaging

A 63-year-old female with biopsy proven tumoral calcinosis presented with progressive and recurrent swelling and tenderness of the right hip, thigh, elbow, and wrist. Both gallium and bone imaging demonstrated intense, congruent uptake in these areas. This is the third case of tumoral calcinosis with sarcoidosis documented in the literature. However, these are the first published bone and gallium scans in a patient with a history of sarcoidosis and tumoral calcinosis.     

Time for sport and health to be formally linked in a positive way

Preventing sports injury has rarely been cited as an appropriate action to respond to the obesity epidemic, and in fact a recent letter has suggested that those playing sport are as responsible for their predicament as those who are obese. This opinion piece argues that it is time for better prevention and management of sports injury to be seen as part of the complex solution to preventing obesity, rather than being a self-inflicted problem that governments should continue to ignore.     

Predictors of a positive baseline bone scan in breast cancer

The aim of this retrospective study was to determine the predictors of a positive bone scan in female patients with breast carcinoma. The participants were 126 females with newly diagnosed breast carcinoma and a baseline bone scan. Patients who had started treatment before their bone scan were excluded. Bone scans were assessed as "no metastases" or "definite skeletal metastases" without knowledge of the patient's predictor variables. Those with "possible metastases" were correlated with other available imaging and clinical information, and recategorized as "no metastases" or "definite skeletal metastases". Results were compared with predictor variables. Significant predictors were increasing age, a higher histopathological grading and positive progesterone receptor status following a forward-stepwise logistic regression analysis. Axillary nodal status, tumour size and oestrogen receptor status did not correlate with a positive bone scan. Not every patient needs a staging bone scan. This study is important because it predicts the need for baseline scintigraphy for specific patients in whom skeletal metastases are more likely to be present or to develop. The findings are particularly valuable in times of worldwide resource scarcity and evolving surgical practice.     

beta -amyloid precursor protein positive axonal bulbs may form in non-head-injured patients

Since the early 1980s axonal bulbs staining positively for beta-amyloid precursor protein (betaAPP) have been used as a marker of diffuse axonal injury (DAI), bulb formation been attributed to shearing forces generated during rotational acceleration/deceleration head injury. This study draws attention to the observation that they may form in the absence of a head injury and, thus, axonal injury cannot be assumed to result from mechanical injury alone. Out of 20 cases with no history of head injury studied, which only showed evidence of neuronal hypoxic change, 11 (55%) showed variable positive staining for betaAPP in a similar anatomical distribution to that previously described for DAI. The role of hypoxia in the formation of axonal bulbs, as well as the possible role of betaAPP as an acute phase protein, are discussed. These observations further clarify the pattern and relationship between neuronal and axonal staining observed following a brain insult and emphasize the possible role of betaAPP as a neuroprotective protein.     

Factors influencing the uptake of 18F-fluoroestradiol in patients with estrogen receptor positive breast cancer

Introduction

¹⁸F-Fluoroestradiol (FES) PET imaging provides a non-invasive method to measure estrogen receptor (ER) expression in tumors. Assessment of factors that could affect the quantitative level of FES uptake is important as part of the validation of FES PET for evaluating regional ER expression in breast cancer.

Methods

This study examines FES uptake in tumors from 312 FES PET scans (239 patients) with documented ER+ primary breast cancer. FES uptake was compared to clinical and laboratory data, treatment prior to or at time of scan, and properties of FES and its metabolism and transport. Linear mixed models were used to explore univariate, threshold-based and multivariate associations.

Results

Sex hormone-binding globulin (SHBG) was inversely associated with FES SUV. Average FES uptake did not differ by levels of plasma estradiol, age or rate of FES metabolism. FES tumor uptake was greater for patients with a higher body mass index (BMI), but this effect did not persist when SUV was corrected for lean body mass (LBM). In multivariate analysis, only plasma SHBG binding was an independent predictor of LBM-adjusted FES SUV.

Conclusions

Calculation of FES SUV, possibly adjusted for LBM, should be sufficient to assess FES uptake for the purpose of inferring ER expression. Pre-menopausal estradiol levels do not appear to interfere with FES uptake. The availability and binding properties of SHBG influence FES uptake and should be measured. Specific activity did not have a clear influence on FES uptake, except perhaps at higher injected mass per kilogram. These results suggest that FES imaging protocols may be simplified without sacrificing the validity of the results.     

The positive bronchus sign in patients with known lung cancer

The positive bronchus sign is the CT finding of a bronchus leading to or contained within the primary mass. A prospective study was performed for the purpose of establishing the correlation between the above sign on CT and the visual and pathological findings on bronchoscopy. The predictive value for the positive bronchus sign was found to be 94% and that of the negative bronchus sign 62%. CT is useful in predicting the likelihood of subsequent bronchoscopy providing positive results.     

Chromosomal radiosensitivity of HIV positive individuals

Purpose:?Radiosensitivity in relation to the human immunodeficiency virus (HIV) status is important in South Africa as the prevalence of HIV infections is high. In this study the in?vitro chromosomal radiosensitivity of HIV positive individuals was investigated and compared with that of HIV negative individuals.

Materials and methods:?Blood samples from 59 HIV positive and 39 HIV negative individuals were exposed in?vitro to doses of 6MV X-rays ranging from 1–4?Gy. Chromosomal radiosensitivity was assessed with the micronucleus assay. Micronuclei are a measure of chromosomal damage and were quantified in at least 500 binucleated lymphoblasts (BN) per sample. Un-irradiated control samples from each donor were also analysed.

Results:?In 47% of HIV positive individuals difficulties with cell stimulation by adding phytohaemagglutinin (PHA) to blood cultures were noticed which resulted in insufficient yield of BN for microscopic analysis. Micronuclei frequencies were consistently higher in irradiated lymphocytes obtained from HIV positive individuals compared to that observed in cells from HIV negative donors. Data for both groups were fitted to the linear-quadratic equation Y?=?αD?+?βD² where Y is the number of micronuclei in 500 binucleated cells and D is the dose in Gy. The fitted parameters for respectively HIV positive and HIV negative lymphocytes are α?=?80.17?Gy^?1, β?=?14?Gy^?2 and α?=?54.5?Gy^?1, β?=?16.2?Gy^?2. The confidence ellipses of these parameters are separated indicating that the increase in radiosensitivity is statistically significant.

Conclusion:?T-lymphocytes of HIV infected individuals were considerably more sensitive to X-rays compared to that of HIV negative donors. This may have implications for normal tissue tolerance during radiotherapy as well as for the radiological health of radiation workers.     

Negative scintigraphy with positive magnetic resonance imaging in bone metastases

We report three patients with known primary tumor in whom radionuclide skeletal imaging for metastatic disease was normal with or without clinical symptomatology referable to this area. Magnetic resonance imaging (MRI) of the spine demonstrated focal areas of abnormal signal intensity in the vertebral bodies of these patients. In all three patients, biopsy confirmed metastatic disease. All the patients received radiation or chemotherapy depending upon the etiology. These preliminary data suggest that MR imaging may be useful in evaluating patients with known primary tumor in whom clinical suspicion persists despite a negative radionuclide bone scan.     

Starch accumulation in the lungs of two infants following positive ventilation

Two infants in different nurseries were found with cardiopulmonary arrest. Cardiopulmonary resuscitation was undertaken immediately in both cases, but was unsuccessful. The cause of death in both infants was diagnosed as sudden unexpected death, probably sudden infant death syndrome, at postmortem investigations. Microscopic examination at autopsy showed the presence of starch granules in the lungs. These were probably introduced during tracheal or nasotracheal intubation for cardiopulmonary resuscitation from gloves sterilized with powdered cornstarch. In both cases cellular staining of foreign bodies was weak and there were few starch granules within macrophages. Our findings suggest that the detection of cornstarch in the lungs can be an artifact arising from surgical gloves used in resuscitation. This artifact may easily occur in infants because of their immature lungs and short respiratory tract. Non-powdered gloves should be worn instead of powdered gloves during tracheal intubation, especially in infants.     

Continuous positive airway pressure with deep inspiration breath hold in left-sided breast radiation therapy

A dosimetric study to evaluate the use of continuous positive airway pressure (CPAP), with free-breathing (CPAP-FB) or with deep inspiration breath hold (DIBH-CPAP) an adjunct and alternative to DIBH to reduce heart and lung dose in the radiation therapy (RT) of breast cancer planned for left side RT with regional nodes and internal mammary. A retrospective analysis of 10 left-sided breast cancer patients whose heart or lung dose constraints were not met after RT planning based on FB or DIBH simulations and were referred for CPAP-based planning. All patients were simulated using FB, DIBH, CPAP-FB, and CPAP-DIBH. Treatment plans were calculated to cover the breast/chest wall and regional nodes using tangential field-in-field technique (FiF). Dose-volume parameters for heart, ipsilateral lung, and contralateral breast were compared using the Wilcoxon signed-rank test. For all RT plans, mean heart dose (Gy) was lower for treatment plans with CPAP: CPAP-FB (mean 3.4 vs 7.4, p = 0.001) and CPAP-DIBH (mean 2.5 vs 7.4, p = 0.006) compared to FB alone. CPAP-DIBH also significantly reduced MHD as compared to DIBH alone (mean 2.5 vs 4.3 Gy, p = 0.013). CPAP-DIBH significantly reduced mean lung dose as compared to both FB (mean 14.4 vs 20.1, p = 0.005) and DIBH alone (mean 14.4 vs 17.4, p = 0.007). Eight of 10 patients did not meet ipsilateral lung V20Gy dose constraints (≥35% of lung receiving 20 Gy) in either the free breathing or DIBH plans, whereas 8 out of 10 met lung V20Gy goal constraints (≤30% of lung receiving 20 Gy) in the CPAP-DIBH plans. Based on the outcomes of our study, CPAP could be a strategy for reducing lung and heart dose, both in patients not able to execute DIBH and as an adjunct in those not deriving sufficient dose reduction from DIBH alone.     

Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis

Objectives

To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images.

Methods

In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules.

Results

The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule’s initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p?<?0.01).

Conclusions

Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination.

Key Points

? Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules ? The risk of hypervascularization in a nodule increased with large size ? Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up

     

晚期非小细胞肺癌 EGFR敏感突变型患者酪氨酸激酶抑制药的疗效和安全性

 目的 观察晚期非小细胞肺癌表皮生长因子受体(EGFR)敏感突变型患者酪氨酸激酶抑制药(EGFR-tyrosine-kinase inhibitor,EGFR- TKI)的疗效和安全性。方法 32例EGFR敏感突变型晚期非小细胞肺癌患者一线化疗后给予EGFR- TKI维持治疗。观察近期疗效、无进展生存期(progression-free-survival, PFS)、总生存期(overall survival, OS)及不良反应。结果 全组CR 3例,PR 7例,SD 18例,PD 4例。有效率 RR 31.3%,疾病控制率DCR 87.5 %;中位PFS 14.9个月(95% CI:11.93 ~17.87个月);中位OS 25.1个月(95% CI:20.8~29.3个月)。全组无重度不良反应发生,治疗耐受良好。皮疹发生率37.5%,腹泻发生率15.6%。结论 晚期非小细胞肺癌 EGFR敏感突变型患者EGFR- TKI维持治疗安全有效。     

Sports correlate with positive living habits. Results from the population survey the Swiss MONICA project

Exercise is associated with positive health habits: Findings from the populations survey of the Swiss MONICA-project. Relatively little is known on population-wide relations of habitual exercise to relevant health factors such as diet, cigarette smoking and overweight. Data from a population-based sample of approximately 800 men and women each, aged 25-64, collected in western Switzerland as a part of an international WHO-project, were used to examine cross-sectionally the interrelationships between different lifestyle factors. Men and women training regularly (i.e. greater than or equal to 2 times/wk) exhibited consistently and highly significantly more favourable health habits, regarding diet (i.e. trimming visible fat, higher intake of fruits, salad and vegetables, yogurt and cottage cheese), nonsmoking, and weight control. Men and women with at least some regular physical activity during leisure-time had in turn more favourable health habits than their sedentary counterparts. In both sexes, educational level was directly related to exercise and a healthy diet, and inversely related to smoking and relative weight. Regularly training men and women also had a significantly improved lipid profile compared to inactive ones. It is concluded from this study that leisure-time physical activity and exercise are related to a positive health behaviour including diet, nonsmoking and efficient weight control. This may suggest that exercise should possibly be integrated into any population-wide attempts and efforts to promote health to enhance primary prevention.     

Clinical hepatic imaging with paramagnetic positive enhancers.

At the present time, there are two types of paramagnetic positive enhancers for hepatic imaging in the United States. One is gadolinium (DTPA) and nonionic forms, and the other is manganese DPDP. Gadolinium derivitives cause the liver to become hyperintense relative to tumors. However, the signal intensity may vary with time. Mn-DPDP causes the liver to be positively enhanced while tumors are negative defects, thus contrasted against the hyperintense background. Both agents have advantages and drawback. During the past 4 years, we have had the opportunity to evaluate both agent. The following will be a clinical summation of our experience with these two compounds. © 1991 Academic Press, Inc.