Combined DCE‐MRI and single‐voxel 2D MRS for differentiation between benign and malignant breast lesions

Dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) and proton (1H) magnetic resonance spectroscopy (MRS) provide structural and biochemical information, including vascular volume, vascular permeability and tissue metabolism. In this study, we performed analysis of the enhancement characteristic from DCE‐MRI and the biochemical information provided by two‐dimensional (2D) Localized Correlated Spectroscopy (L‐COSY) MRS to determine the sensitivity and specificity of using DCE‐MRI alone compared to the combination with 2D MRS. The metabolite ratios from the 2D MRS spectra were analyzed using multivariate statistical analyses to determine a method capable of automatic separation of the patient cohort into malignant and benign lesions. A total of 24 lesions were studied with 21 diagnosed accurately using the enhancement characteristics alone resulting in sensitivity and specificity of 100% and 73%, respectively. Analysis of the 2D MRS data demonstrated a significant difference (p < 0.05) in 12 of 18 metabolite ratios analyzed for malignant compared to benign lesions. Previous research focused on utilizing the choline signal to noise ratio (SNR) as a marker for malignancy has been verified using 2D MRS in this study. Using Fisher's linear discriminant test using water (WAT)/olefinic fat diagonal (UFD), choline (CHO)/fat (FAT), CHO/UFD, and FAT/methyl fat (FMETD) as predictors the sensitivity and specificity increased to 92% and 100%, respectively. Using the Classification and Regression Tree (CART) statistical analysis the resulting sensitivity and specificity were 100% and 91%, respectively, with the most accurate predictor for differentiating malignant and benign determined to be FAT/FMETD. The cases within the study that presented a indeterminate diagnosis using DCE‐MRI alone were able to be accurately diagnosed when the metabolic information from 2D MRS was incorporated. The results suggest improved breast cancer detection through the combination of morphological and enhancement information from DCE‐MRI and metabolic information from 2D MRS. Copyright © 2010 John Wiley & Sons, Ltd.     

Estimating energy expenditure using accelerometers

The purpose of this study was to examine the validity of published regression equations designed to predict energy expenditure (EE) from accelerometers (Actigraph, Actical, and AMP-331) compared to indirect calorimetry, over a wide range of activities. Forty-eight participants (age: 35 ± 11.4 years) performed various activities that ranged from sedentary behaviors (lying, sitting) to vigorous exercise. The activities were split into three routines of six activities, and each participant performed at least one routine. The participants wore three devices (Actigraph, Actical, and AMP-331) and simultaneously, EE was measured with a portable metabolic system. For the Actigraph, 15 previously published equations were used to estimate EE from the accelerometer counts. For the Actical, two published equations were used to estimate EE from the accelerometer counts. For the AMP-331 we used the manufacturer’s equation to estimate EE. The Actigraph and Actical regressions tended to overestimate walking and sedentary activities and underestimate most other activities. The AMP-331 gave a close estimate of EE during walking, but overestimated sedentary/light activities and underestimated all other activities. The only equation not significantly different from actual time spent in both light and moderate physical activity was the Actigraph Freedson kcal equation. All equations significantly underestimated time spent in vigorous physical activity (P < 0.05). In conclusion, no single regression equation works well across a wide range of activities for the prediction of EE or time spent in light, moderate, and vigorous physical activity.Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.     

Multi‐scale network regression for brain‐phenotype associations

Brain networks are increasingly characterized at different scales, including summary statistics, community connectivity, and individual edges. While research relating brain networks to behavioral measurements has yielded many insights into brain‐phenotype relationships, common analytical approaches only consider network information at a single scale. Here, we designed, implemented, and deployed Multi‐Scale Network Regression (MSNR), a penalized multivariate approach for modeling brain networks that explicitly respects both edge‐ and community‐level information by assuming a low rank and sparse structure, both encouraging less complex and more interpretable modeling. Capitalizing on a large neuroimaging cohort (n = 1, 051) , we demonstrate that MSNR recapitulates interpretable and statistically significant connectivity patterns associated with brain development, sex differences, and motion‐related artifacts. Compared to single‐scale methods, MSNR achieves a balance between prediction performance and model complexity, with improved interpretability. Together, by jointly exploiting both edge‐ and community‐level information, MSNR has the potential to yield novel insights into brain‐behavior relationships.     

Treatment of refractoriness to platelet transfusion by protein A column therapy

Ten thrombocytopenic patients (platelets < 10–24 × 10(9)/L) who were refractory to platelet transfusion were investigated for their responsiveness to staphylococcal protein A column therapy. Nine patients had previously been treated with steroids, intravenous immune globulin, and/or other forms of immunosuppressive therapy without improvement in their transfusion response. All patients were receiving multiple platelet transfusions without achieving 1-hour corrected count increments (CCIs) > or = 7500. Eight patients had antibodies that reacted with platelets and were directed against HLA class I antigens, ABO antigens, and/or platelet-specific alloantigens. Plasma (500-2000 mL) from each patient was passed over a protein A silica gel column and then returned to the patient. Patients received from 1 to 14 treatments. A positive response to protein A therapy was defined as at least a doubling of the pretreatment platelet count and/or two successive 10- to 120-minute posttransfusion CCIs > or = 7500. Following plasma treatments, 6 of 10 patients responded with daily platelet counts that averaged 48 +/− 11 × 10(9) per L as compared with counts of 16 +/− 7 × 10(9) per L (p < 0.0005) before treatment. Posttransfusion CCI values determined in four of these patients averaged 2480 +/− 810 and 10,010 +/− 3540 (p < 0.005) before and after treatment, respectively. In contrast, among the four unresponsive patients, platelet counts averaged 10 +/− 9 and 13 +/− 10 × 10(9) per L (p = NS), respectively, while posttransfusion CCIs were 700 +/− 1410 and 1520 +/− 2460 (p = NS), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cognitive function in early psychosis patients from a lower middle-income country

Objectives: To establish evidence of cognitive changes in early psychosis (EP) patients compared to healthy controls (HC) in Pakistan.

Methods: Fifty-one participants with EP were recruited from psychiatric units in Karachi and Rawalpindi, Pakistan and matched with 51 HC. Neurocognitive domains were assessed using standardised neuropsychological tests [the Stroop test, block design, Matrix Reasoning, picture completion, object assembly, oral fluency, memory for design, Coughlan learning task (verbal and visual)].

Results: EP patients had higher scores than controls for both Stroop tests (T1: EP?=?122 HC?=?65, p?<.001; T2: EP?=?190 HC?=?153, p?=?.007) and memory for design test (EP?=?10 HC?=?3, p?=?.005). EP group had lower values for block design (EP?=?4, HC?=?11, p?=?.01), category fluency (EP?=?18.9, HC?=?26.1, p?p?p?p?=?.003) and object assembly (EP?=?10.7, HC?=?15.5, p?=?.002). There were limited significant associations between cognitive performance and PANSS scores.

Conclusions: Reduced cognitive performance was found across multiple domains in Pakistani EP patients, which suggests that impaired cognitive performance is homogenous in patients with schizophrenia, regardless of ethnicity.     

Factors impacting the accuracy of intra‐operative evaluation of sentinel lymph nodes in breast cancer

Sentinel lymph node dissection (SLND) is a standard axillary staging technique in breast cancer and intraoperative sentinel lymph node (SLN) assessment is important for decision‐making regarding additional treatment and reconstruction. This study was undertaken to investigate clinicopathologic factors impacting the accuracy of intraoperative SLN evaluation. Records of patients with clinically node‐negative, invasive breast cancer who underwent SLND with frozen section intraoperative pathologic evaluation from 2004 to 2007 were reviewed. Intraoperative SLN assessment results were compared to final pathology. Patients with positive SLNs that were initially reported as negative during intraoperative assessment were considered false negative (FN) events. Primary tumor histology, grade, receptor status, size, lymphovascular invasion (LVI), multifocality, neoadjuvant chemotherapy or hormonal therapy, number of SLNs retrieved, and SLN metastasis size were evaluated. The study included 681 patients, of whom 262 (38%) received neoadjuvant therapy. There were 183 (27%) patients who had a positive SLN on final pathology, of whom 60 (33%) had FN events. On univariate analysis, lobular histology, favorable histology, absence of LVI and micrometastasis were associated with a higher FN rate. On multivariate analysis, favorable and lobular histology and micrometastasis were independent predictors of FN events whereas LVI and receipt of neoadjuvant therapy were not statistically significant predictors. The accuracy of intraoperative SLN evaluation for breast cancer is affected by primary tumor histology and size of the SLN metastasis. There was no significant association between neoadjuvant therapy and the FN rate by intraoperative assessment. This information may be helpful in counseling patients about their risk for a FN intraoperative SLN assessment and for planning for immediate breast reconstruction in patients undergoing mastectomy.     

Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20‐question anonymous web‐based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management.     

Myometrial invasion by endometrial carcinoma: sonographic assessment

The depth of myometrial invasion by endometrial carcinoma was evaluated using real-time sonography (US) in 20 patients with histologically proved adenocarcinoma of the endometrium. In 14 of 20 (70%) cases, US-based estimation of the depth of myometrial invasion was within 10% of the actual measurement in the gross specimen. The US-based estimation of tumor invasion was low in seven patients, high in four patients, and agreed with pathologic findings (+/- 5%) in nine patients. In four patients with polypoid intraluminal extension of tumor, a deeply invasive tumor was suspected on US but was not found on pathologic examination. In 12 superficially invasive tumors, the continuity of the demarcating subendometrial halo was intact in nine and incomplete in three. In six patients with deeply invasive tumors, this zone was partially disrupted in four, totally disrupted in one, and intact in one. Errors of estimation of the depth of myometrial invasion on US most frequently occurred when a tumor had a significant intraluminal polypoid extension. Demonstration of a subendometrial halo usually indicated superficial invasion, whereas the absence of a halo was frequently associated with deep invasion.     

Focal liver masses: differential diagnosis with pulsed Doppler US

Duplex Doppler ultrasound (US) was used in 68 consecutive patients with focal liver lesions, including 12 hepatocellular carcinomas, one cholangiocarcinoma, 37 metastases, 15 hemangiomas, one hemangioendothelioma, and two focal nodular hyperplasias. Of the hepatocellular carcinomas, six were diffusely hyperechoic, two were hypoechoic, two were single hyperechoic lesions, and two were multifocal and hyperechoic. All ten tumors with Doppler shifts of 5 kHz or above proved to be hepatocellular carcinomas. The other two hepatocellular carcinomas showed Doppler shifts of 3 kHz. In contrast, no hemangioma showed shifts above 0.7 kHz, and ten of the 15 gave no detectable signal. Of the metastases, 20 gave no signal and 17 had signals of up to 4 kHz. Three-kilohertz signals were also obtained from a cholangiocarcinoma, a hemangioendothelioma, and focal nodular hyperplasia. Correlation with angiographic findings suggested that the high-velocity Doppler signals were associated with large pressure gradients due to arteriovenous shunting. Duplex Doppler US can therefore aid in the differential diagnosis of diffuse and focal liver lesions.