Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤4 cm) at 3.0T Magnetic Resonance Imaging

Background:

The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤4 cm).

Methods:

In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm² and values compared via the Kruskal–Wallis and Mann–Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression.

Results:

The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10⁻³ mm²/s), ccRCCs ([1.53 ± 0.31] × 10⁻³ mm²/s) and the normal renal parenchyma ([2.22 ± 0.12] × 10⁻³ mm²/s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10⁻³ mm²/s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs.

Conclusions:

DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.     

Magnetic Resonance Imaging of Transplanted Neural Stem Cells in Parkinson Disease Rats

Parkinson's disease (PD) is a degeneration disease with a main pathological change of characteristic deletion of nigra dopaminergic neurons. Now it is well known that neural stem cells (NSCs) reside in specific mammal brain region[1]. NSCs are optimal for cell-replacement therapy, thus making it a complementary therapeutic strategy to the traditional pharmacological therapies and fetal mesencephalic tissues transplantation[2]. It is important to distinguish grafted NSCs from host brain cel…     

Magnetic resonance imaging findings in Lhermitte-Duclos disease:reports of three cases

Lghaernmgliitotcey-Dtoumcalos o fdis ethaese c(e rLeDbeDllu)m,, or is dy aspla rsatriechamartomatous lesion characterized by a slowly enlargingmass within the cerebellar cortex·The disease revealsunique appearance on magnetic resonance imaging(MRI)·Recognition of the imaging features makes thecorrect diagnosis possible even without a pathologicalexamination·Three cases are presented and analyzed inthis report·CASE REPORTSCase 1A 32-year-old man visited our clinic complaining ofinte…     

Value of Apparent Diffusion Coefficient（ADC） of Diffusion eighted Magnetic Resonance Imaging in Common Renal Disease Diagnosis

Objective:To find the value of the apparent diffusion coefficient (ADC) of diffusion weighted magnetic resonance imaging of common renal diseases. Methods: There were 30 healthy subjects and 81 patients with renal lesions (56 cases of renal carcinoma, 18 lesions of 12 cases of renal angiomyolipoma, and 21 lesions of 13 cases of renal cysts). Conventional magnetic resonance imaging and diffusion weighted magnetic resonance imaging were carded out. We measured the average ADC value of the renal lesions and normal kidneys. ADC maps from different b values were generated by a statistical package. Results: The ADC values of normal kidneys with three different motion-probing gradients(b=500, 800, 1000 sec/mm2) were 2.78±0.14×10-3mm2s-1,2.45±0.13×10-3mm2s-1, 2.13±0.14×10-3mm2s-1, respectively. The ADC values of renal cell carcinoma with three different motion-probing gradients(b=500, 800, 1008 sec/mm2) were 1.63±0.14×10-3mm2s-1, 1.31±0.18×10-3mm2s-1, 1.07±0.15-310-3mm2s-1, respectively. Among the renal cell carcinoma, the ADC value of clear cell type were 1.67±0.09×10-3mm2s-1, 1.36±0.13×10-3mm2s-1, 1.15±0.14×10-3mm2s-1,respectively; the ADC values of granular cell type were 1.59±0.19×10-3mm2s-1, 1.25±0.22×10-3mm2s-1, 0.97±0.12×10-3mm2s-1, respectively. The ADC values of renal angiomyolipoma with three different motion-probing gradients(b=500, 800, 1008 sec/mm2) were 0.88±0.08×10-3mm2s-1, 0.63±0.07×10-3mm2s-1, 0.43±0.04×10-3mm2s-1, respectively. The ADC values of renal cystic lesions with three different motion-probing gradients(b=500, 800, 1000 sec/mm2) were 3.73±0.18×10-3mm2s-1, 3.44±0.13×10-3mm2s-1, 3.09±0.21×10-3mm2s-1, respectively. Statistically significant differences exists between the ADC values of normal kidney, renal carcinomas, renal angiomyolipomas and renal cysts when the b value is the same. Among the different cell types of renal carcinomas, the ADC value of granular cell carcinoma is lower than that of clear cell carcinomas. Conclusion: It is of benefit in diagnosing and distinguishing between benign and malignant renal tumors to know the ADC values in diffusion weighted magnetic resonance imaging. Furthermore, these values help to know the internal structure of the tumor and the tumor typel, which is helpful to the treatment and in predicting the patient' s prognosis.     

Study on the Regulatory Effect of Electro-acupuncture on Hegu Point （LI4） in Cerebral Response with Functional Magnetic Resonance Imaging

Objective To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (LI4) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating LI4, for exploring the mechanism of its effect in potential clinical application. Methods EA was applied at volunteers’ right LI4 (of 9 subjects in the LI4 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 × 1 × 1 mm³ used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging. Results Data from 3 testees of the 9 subjects in the LI4 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients’ location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of LI4 group and 5 subjects of the control group (P<0.01). In the LI4 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil’s island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe. Conclusion The effects of EA LI4 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA LI4 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect’s cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA LI4 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research. Supported by the National Natural Science Foundation (No. 90209031)     

Application of Large Dosage of Salvia Miltiorrhiza Compositae in Treating 23 Patients of Newborn Hypoxic Ischemic Encephalopathy

Ａｐｐｌｉｃａｔｉｏｎ　ｏｆ　Ｌａｒｇｅ　Ｄｏｓａｇｅ　ｏｆ　Ｓａｌｖｉａ　Ｍｉｌｔｉｏｒｒｈｉｚａ　Ｃｏｍｐｏｓｉｔａｅ　ｉｎ　Ｔｒｅａｔｉｎｇ　２３　Ｐａｔｉｅｎｔｓ　ｏｆ　Ｎｅｗｂｏｒｎ　Ｈｙｐｏｘｉｃ　Ｉｓｃｈｅｍｉｃ　Ｅｎｃｅｐｈａｌｏｐａ...     

Therapeutic effects of mGluRs antagonists on diffuse brain injury in rats

Objective To study the neuroprotective effects of antagonist or agonist of metabotropic glutamate receptors (mGluRs) on diffuse brain injury (DBI) in rats. Methods All rats were randomly divided into four groups and injected intraccerebro-ventricularly with 10 μl of MCPG (Group Ⅰ ,antagonists),DCG-Ⅳ (Group Ⅱ ,agonists) or L-AP4 (Group Ⅲ , mGluRs) respectively 1 hour after DBI, while all control rats were injected with normal saline instead. Then, the motor and cognitive performance, the water content and the number of injured neurons were recorded at different intervals after DBI. Results There was no significant change in the mortality of rats with DBI after treatment with MCPG,DCG-Ⅳ or L-AP4. MCPG or DCG-Ⅳ .especially MCPG could ameliorate the mortor and cognitive performance and decrease water contents and the damaged neurons in the parietal cortex of the rats with DBI (P<0.05). However,L-AP4 did not have the effect above mentioned (P > 0. 05 ). Conclusion MCPG and DCG-Ⅳ, especially MCPG, hav     

Experimental and clinical studies of traumatic brain injury in China.

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Chinese Herbal Medicine Xingnaojing Injection (醒脑静注射液) for Hypoxic Ischemic Encephalopathy in Newborns: A Systematic Review and Meta-Analysis

Objectives: To evaluate the efficacy and safety of Chinese herbal medicine Xingnaojing Injection(醒脑静注射液) for newborns with hypoxic ischemic encephalopathy(HIE). Methods: Literature was identified by searching the Pub Med, EMBASE, Cochrane Library, Cochrane Central, and four Chinese literature databases from the establishment of database to October in 2013. Relevant reference lists were also screened. Two reviewers independently evaluated the methodological quality of included studies. We also conducted the meta-analysis. Results: Thirteen trials involving 1,169 patients were included. There was no trial reported death or disability at the end of follow-up period. Meta-analysis of 4 trials(n=371) showed that there was no significant difference in the reduction of mortality [risk ratios(RR)=0.48, 95% confidence intervals(CI, 0.21, 1.13), P=0.09] between the Xingnaojing and control groups. Meta-analysis of 5 trials(n=359) showed that there was significant difference in reducing the major neurodevelopmental disability [RR=0.36, 95% CI(0.19, 0.66), P=0.001]. Meta-analysis of 6 trials(n=447) showed that there was a significant difference in the author self-defined symptom improvement [RR=1.25, 95% CI(1.14, 1.37), P0.01]. No fatal side-effects were reported. Conclusion: Based on the limited evidence, the routine use of Xingnaojing Injection for treatment of HIE in newborns is not recommended. Further well-conducted trials are justified.     

Bullous presentation of Henoch-Schönlein purpura in an adult

Henoch-Sch?nlein purpura is a small vessel vasculitis occurring mainly in childhood and rarely in adulthood. Typical cutaneous eruption may begin as macular or urticarial erythematous lesions progressing to a palpable purpura. In adults, the disease has a propensity to be more severe and chronic and affects mainly the ankles and feet. Bullae, vesicles and ulcers are occasionally seen in this group. The prognosis depends on renal involvement, commonly seen in adults. We report a new case of Henoch-Sch?nlein purpura in a 36-year-old man presenting with a bullous eruption followed by the appearance of abdominal pain and hematuria.     

Effects of acute brain injury on the contents of neurotensin in brain areas,pituitary gland and plasma in rats

The changes of immunoreactive neurotensin(ir-NT)contents in the brain areas,pituitary gland and plasma in the traumatized rats were observed in the present study.The results of radioimmunoassay exhibited significant changes of the ir-NT contents inthe hypothalamus,pituitary gland,plasma,injured tissue,hippocampus,central gray andspinal cord in the posttraumatic rats at different intervals.A predominant characteristicsof the changes of ir-NT levels in the brain areas,pituitary gland and plasma was thedramatical decrease at various times except for the hypothalamus,central gray andhippocampus with biphasic alterations.The ir-NT contents in the frontal cortex andpons-medulla also displayed changes to different extent under the acute craniocerebraltrauma condition.These results suggest that NT may play a role in the pathophysiologyof traumatic head injury.     

The prognostic value of gray–white matter ratio on brain computed tomography in adult comatose cardiac arrest survivors

Background

Recent studies suggested that the gray–white matter ratio (GWR) determined from brain computed tomography (CT) scans may be a reliable predictor of poor neurological outcomes. The aim of study was to evaluate the association between the GWR and the outcomes in adult comatose cardiac arrest (CA) survivors in Chinese.

Treatment of traumatic brain injury in rats with transplantation of human amniotic cells

Traumatic brain injury （TBI）, which is an important reason of human mortality and morbidity in industrialized countries, still cannot be treated effectively. Since the self-repair capacity of brain is limited, cellular transplantation in TBI may be a therapeutic option.Human amniotic cells （HACs） from fertilized ovum are able to differentiate into all the tissues of the body. They can not only express the markers of neuronal and glial cells^1 but also synthesize and release the neurotrophic factors.^2 Moreover, transplanted HACs rarely induce immunologic rejection.^3,4 In this study, we investigated whether HAC cultures conditioned by traumatic brain tissue extracts can acquire the phenotype of neuron, and examined the effects of transplanted HACs on the affected hindlimb of rats with TBI.     

Mechanisms and innovations: Traumatic brain injury: Can the consequences be stopped?

Traumatic brain injury is a leading cause of morbidity and death in both industrialized and developing countries. To date, there is no targeted pharmacological treatment that effectively limits the progression of secondary injury. The delayed progression of deterioration of grey and white matter gives hope that a meaningful intervention can be applied in a realistic timeframe following initial trauma. In this review we discuss new insights into the subcellular mechanisms of secondary injury that have highlighted numerous potential targets for intervention.     

Nestin expression and proliferation of ependymal cells in adult rat spinal cord after injury

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