Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models

BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.

Efficient loading of cesium atoms in a magnetic levitated dimple trap

We report a detailed study of magnetically levitated loading of ultracold ^(133)Cs atoms in a dimple trap.The atomic sample was produced in a combined red-detuned optical dipole trap and dimple trap formed by two small waist beams crossing a horizontal plane.The magnetic levitation for the ^(133)Cs atoms forms an effective potential for a large number of atoms in a high spatial density.Dependence of the number of atoms loaded and trapped in the dimple trap on the magnetic field gradient and bias field is in good agreement with the theoretical analysis.This method has been widely used to obtain the Bose–Einstein condensation atoms for many atomic species.

Combination of three-gene immunohistochemical panel and magnetic resonance imaging-detected extramural vascular invasion to assess prognosis in non-advanced rectal cancer patients

AIM To identify a small, clinically applicable immunohistochemistry(IHC) panel that could be combined with magnetic resonance imaging(MRI)-detected extramural vascular invasion(EMVI) for assessment of prognosis concerning the non-advanced rectal cancer patients prior to operation.METHODS About 329 patients with pathologically confirmed rectal carcinoma(RC) were screened in this research, all of whom had been examined via an MRI and were treatment-na?ve from July 2011 to July 2014. The candidate proteins that were reported to be altered by RC were examined in tissues by IHC. All chosen samples were adopted from the fundamental cores of histopathologically confirmed carcinomas during the initial surgeries.RESULTS Of the three proteins that were tested, c-MYC, PCNA and TIMP1 were detected with relatively significant expression in tumors, 35.9%, 23.7% and 58.7% respectively. The expression of the three proteins were closely connected with prognosis(P = 0.032, 0.003, 0.021). The patients could be classified into different outcome groups according to an IHC panel(P < 0.01) via these three proteins. Taking into consideration known survival covariates, especially EMVI, the IHC panel served as an independent prognostic factor. The EMVI combined with the IHC panel could categorize patients into different prognostic groups with distinction(P < 0.01).CONCLUSION These studies argue that this three-protein panel of c-MYC, PCNA, coupled with TIMP1 combined with MRIdetected EMVI could offer extra prognostic details for preoperative treatment of RC.

Hepatic MR imaging using IDEAL-IQ sequence:Will Gd-EOB-DTPA interfere with reproductivity of fat fraction quantification?

BACKGROUND Iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence(IDEAL-IQ)is based on chemical shift-based water and fat separation technique to get proton density fat fraction.Multiple studies have shown that using IDEAL-IQ to test the stability and repeatability of liver fat is acceptable and has high accuracy.AIM To explore whether Gadoxetate Disodium(Gd-EOB-DTPA)interferes with the measurement of the hepatic fat content quantified with the IDEAL-IQ and to evaluate the robustness of this technique.METHODS IDEAL-IQ was used to quantify the liver fat content at 3.0T in 65 patients injected with Gd-EOB-DTPA contrast.After injection,IDEAL-IQ was estimated four times,and the fat fraction(FF)and R2* were measured at the following time points:Precontrast,between the portal phase(70 s)and the late phase(180 s),the delayed phase(5 min)and the hepatobiliary phase(20 min).One-way repeated-measures analysis was conducted to evaluate the difference in the FFs between the four time points.Bland-Altman plots were adopted to assess the FF changes before and after injection of the contrast agent.P<0.05 was considered statistically significant.RESULTS The assessment of the FF at the four time points in the liver,spleen and spine showed no significant differences,and the measurements of hepatic FF yielded good consistency between T1 and T2[95%confidence interval:-0.6768%,0.6658%],T1 and T3(-0.3900%,0.3178%),and T1 and T4(-0.3750%,0.2825%).R2* of the liver,spleen and spine increased significantly after injection(P<0.0001).CONCLUSION Using the IDEAL-IQ sequence to measure the FF,we can obtain results that will not be affected by Gd-EOB-DTPA.The high reproducibility of the IDEAL-IQ sequence makes it available in the scanning interval to save time during multiphase examinations.

Preliminary clinical application of total free-breathing cardiac MR examination

Objective To observe the clinical application value of total free-breathing cardiac MR(CMR)examination preliminarily.Methods Two patients who underwent CMR scanning under free-breathing state,including cine,motion correction T1 and T2 mapping,blood flow imaging,and late gadolinium enhancement scanning were retrospectively enrolled,and the qualities of the above images were evaluated and compared with that of conventional CMR images under breath-holding state.Results No significant difference of imaging quality was found between total free-breathing and conventional breath-holding CMR.The differences of left ventricular ejection fraction,cardiac output,left ventricular end-diastolic volume index and left ventricular mass measured based on CMR images under different breath conditions were limited.Conclusion Total free-breathing CMR was feasible in clinical practice,which could provide"one-stop"evaluation of cardiac structure,function and myocardial histological characteristics,hence having promising clinical prospects.

Detecting dopaminergic neuronal degeneration using diffusion tensor imaging in a rotenone-induced rat model of Parkinson's disease: fractional anisotropy and mean diffusivity values

Dopamine content in the basal ganglia is strongly associated with the degree of dopaminergic neuron loss in the substantia nigra pars com- pacta. Symptoms of Parkinson＇s disease might not arise until more than 50% of the substantia nigra pars compacta is lost and the dopamine content in the basal ganglia is reduced by more than 80%. Greater diagnostic sensitivity and specificity would allow earlier detection of Parkinson＇s disease. Diffusion tensor imaging is a recently developed magnetic resonance imaging technique that measures mean diffusiv- ity and fractional anisotropy, and responds to changes in brain microstructure. When the microscopic barrier （including cell membranes, microtubules and other structures that interfere with the free diffusion of water） is destroyed and extracellular fluid volume accumulates, the mean diffusivity value increases; when the integrity of the microstructure （such as myelin） is destroyed, fractional anisotropy value decreases. However, there is no consensus as to whether these changes can reflect the early pathological alterations in Parkinson＇s disease. Here, we established a rat model of Parkinson＇s disease by injecting rotenone （or sunflower oil in controls） into the right suhstantia nigra. Diffusion tensor imaging results revealed that in the stages of disease, at 1, 2, 4, and 6 weeks after rotenone injection, fiactional anisotropy value decreased, but mean diffusivity values increased in the right substantia nigra in the experimental group. Fractional anisotropy values were lower at 4 weeks than at 6 weeks in the right substantia nigra of rats from the experimental group. Mean diffusivity values were mark- edly greater at 1 week than at 6 weeks in the right corpus striatum of rats from the experimental group. These findings suggest that mean diffusivity and fractional anisotropy values in the brain of rat models of Parkinson＇s disease 4 weeks after model establishment can reflect early degeneration of dopaminergic neurons. ＇The change in fractional anisotropy values after destruction of myelin integrity is likely to be of greater early diagnostic significance than the change in mean diffusivity values.

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.

Therapeutic effect and mechanism of breviscapine on cisplatin-induced nephrotoxicity in mice

Objective:To observe the protective effect of breviscapineon mice with cisplatin-induced nephrotoxicity.Methods:Mice were given a single injection of cisplalin(8 mg/kg,up.);then,breviscapine was given to mice at 25 mg/kg and 50 mg/kg doses,respectively,once a day for seven days.Renal tissue structure was observed after animals were sacrificed.Blood urea nitrogen(BUN),serum creatinine(Scr),lipid peroxide(MDA) and superoxide dismutase(SOD) serum levels were detected;and MDA,glutathione peroxidase,and SOD levels in the renal cortex were detected.Results:Compared with the blank control group(BCG),the kidney pathological damage of mice in the model control group(MCG) was more severe.After applying different doses of breviscapine,different degrees of renal injury improvement appeared.Compared with the BCG,the serum levels of Scr and BUN in the MCG increased to(89.92±6.78) μmoL/L and(15.32±4.53) mmoL/L.The differences were statistical significant(P<0.01).Compared with the MCG,the serum levels of Scr and BUN in the Bre low-dose groups and Bre high-dose groups decreased significantly(P<0.05).Compared with the BCG,the MDA levels in serum and in the renal cortex in the MCG significantly increased,while the SOD levels significantly decreased.Both the differences were statistically significant(P<0.01).In the Bre low-dose groups and Bre high-dose groups,MDA levels in serum and in the renal cortex significantly decreased,while SOD and glutathione peroxidase levels in the renal cortex significantly increased,compared with the MCG;and the differences were statistically significant(P<0.05).Conclusions:Breviscapine can reduce cisplatin induced renal toxicity in mice and it's possible through inhibition of renal tubule cell lipid peroxidation and reduces the nephrotoxicity of cisplatin.

Diagnosis of intravenous leiomyomatosis extending to heart with emphasis on magnetic resonance imaging

Background Intravenous leiomyomatosis is a rare neoplasm, and its cardiac extension is often overlooked or misdiagnosed. The purpose of this study was to explore the imaging features of intravenous leiomyomatosis with cardiac extension, especially the value of magnetic resonance imaging in differential diagnosis. Methods Between July 2005 and August 2008, 4 cases of intravenous leiomyomatosis with cardiac extension were resected in Cangzhou Central Hospital. Three cases had echocardiography performed, two had post contrast scans of CT performed, and two had MRI performed. Between July 2005 and May 2010, 25 cases of histopathologically proven other kinds of tumors involving the inferior vena cava and right atrium were compared for discussion of differential diagnosis. Results Intravenous leiomyomatosis with cardiac extension demonstrated a hyperechoic elongated mobile mass extending from the inferior vena cava to the right atrium with or without evidence of protruding into the right ventricle on echocardiography. The lesion was enhanced heterogeneously on post contrast scans of CT and was of relatively lower density compared to the enhanced blood in the inferior vena cava and right atrium, with common iliac vein and the ipsilateral internal iliac and ovarian veins involved in some cases. The untreated uterus myoma demonstrated enlargement of the uterus with heterogeneous contrast enhancement. On MRI, the lesion looked like a luffa vegetable sponge on FIESTA coronal images and a sieve pore on T2-weighted axial images. All four tumors were removed successfully, and follow up of one to four years revealed no recurrence. The 25 cases of histopathologically proven other kinds of tumors involving inferior vena cava and right atrium had their own imaging features different from those seen on intravenous leiomyomatosis with cardiac extension. With reference to their medical history, differential diagnosis can often be made. Conclusion The imaging appearance of intravenous leiomyomatosis has some unique features, and the luffa vegetable sponge and sieve pore like appearance on MRI may be helpful for differential diagnosis.

Liver transplantation for metastatic neuroendocrine tumor: A case report and review of the literature

Neuroendocrine tumors are divided into gastrointestinal carcinoids and pancreatic neuroendocrine tumors. The WHO has updated the classification of these lesions and has abandoned the term ＂carcinoid＂. Both types of tumors are divided into functional and non-functional tumors. They are characterized by slow growth and frequent metastasis to the liver and may be limited to the liver for long periods. The therapeutic approach to hepatic metastases should consider the number and distribution of the liver metastases as well as the severity of symptoms related to hormone production and tumor bulk. Surgery is generally considered as the first line therapy. In patients with unresectable liver metastases, alternative treatments are dependent on the type and the growth rate. Initial treatments consist of long acting somatostatin analogs and/or interferon. Streptozocin-based chemotherapy is usually reserved for symptomatic patients with rapidly advancing disease, but generally the therapy is poorly tolerated and its effects are short-lived. Locoregional therapy directed such as hepatic-artery embolization and chemoembolization, radiofrequency thermal ablation and cryosurgery, is often used instead of systemic therapy, if the disease is limited to the liver. However, liver transplantation should be considered in patients with neuroendocrine metastases to the liver that are not accessible to curative or cytoreductive surgery and if medical or Iocoregional treatment has failed and if there are life threatening hormonal symptoms. We report a case of liver transplantation for metastatic neuroendocrine tumor of unknown primary source and provide a detailed review of the world literature on this controversial topic.

Can DKI-MRI predict recurrence and invasion of peritumoral zone of hepatocellular carcinoma after transcatheter arterial chemoembolization?

BACKGROUND Hepatocellular carcinoma(HCC)is a major cause of cancer-related mortality worldwide.Transcatheter arterial chemoembolization(TACE)has been performed as a palliative treatment for patients with HCC.However,HCC is easy to recur after TACE.Magnetic resonance imaging(MRI)has clinical potential in evaluating the TACE treatment effect for patients with liver cancer.However,traditional MRI has some limitations.AIM To explore the clinical potential of diffusion kurtosis imaging(DKI)in predicting recurrence and cellular invasion of the peritumoral liver zone of HCC after TACE.METHODSSeventy-six patients with 82 HCC nodules were recruited in this study and underwent DKI afterTACE. According to pathological examinations or the overall modified response evaluationcriteria in solid tumors (mRECIST) criterion, 48 and 34 nodules were divided into true progressionand pseudo-progression groups, respectively. The TACE-treated area, peritumoral liver zone, andfar-tumoral zone were evaluated on DKI-derived metric maps. Non-parametric U test and receiveroperating characteristic curve (ROC) analysis were used to evaluate the prediction performance ofeach DKI metric between the two groups. The independent t-test was used to compare each DKImetric between the peritumoral and far-tumoral zones of the true progression group.RESULTSDKI metrics, including mean diffusivity (MD), axial diffusivity (DA), radial diffusivity (DR), axialkurtosis (KA), and anisotropy fraction of kurtosis (Fak), showed statistically different valuesbetween the true progression and pseudo-progression groups (P < 0.05). Among these, MD, DA,and DR values were higher in pseudo-progression lesions than in true progression lesions,whereas KA and FAk values were higher in true progression lesions than in pseudo-progressionlesions. Moreover, for the true progression group, the peritumoral zone showed significantlydifferent DA, DR, KA, and FAk values from the far-tumoral zone. Furthermore, MD values of theliver parenchyma (peritumoral and far-tumoral zones) were significantly lower in the trueprogression group than in the pseudo-progression group (P < 0.05).CONCLUSIONDKI has been demonstrated with robust performance in predicting the therapeutic response ofHCC to TACE. Moreover, DKI might reveal cellular invasion of the peritumoral zone by moleculardiffusion-restricted change.

Optimization of Liver Iron Load Assessment by Pixel-Based T2* MRI in Thalassemic Patients

Purpose: To improve liver iron load assessment by investigating the precision of different approaches of T2* Measurement. Background: Iron overload is a major problem in the treatment of thalassemic patients. Liver iron concentration (LIC) is an important index toward the management of body iron load. The accuracy of iron load estimation may suffer from the methodology of T2* measurement and there is no complete agreement upon the best approach of T2* calculation. Methods: 32 β-thallasemic patients (18 male) with the mean age of 20.0 ± 6.5 years were involved in this study. A multi-echo fast gradient-echo technique on a 1.5 T MRI system was used to measure liver iron overload and the T2* map of liver was reconstructed on a pixel-by-pixel basis. The T2* map and MRI images were utilized to deter- mine accurate location of ROI (region of interest). The mean of T2* were computed from the ROIs. The reproducibility of calculated T2* values in two methods were obtained. Moreover, the mean of the pixel’s T2* was calculated in the entire liver parenchyma of one slice. The T2* value of the entire slice was compared with the ROI approach. Results: In the ROI based method, the CoV for the intra-observer reproducibility was 8.5% and for the inter-observer was 9.78%. In the pixel based method, the CoVs for intra-observer and inter-observer reproducibility were 2.79% and 3.91%. There was an acceptable correlation (r = 0.96) between the T2* values calculated by the ROI and the entire slice. Conclusions: The pixel-based approach is more precise to determine the appropriate placement of the ROI. The assessment of T2* in the entire slice reduces the user-based errors significantly.

CT Differentiation of Diffuse Malignant Peritoneal Mesothelioma, Tuberculous Peritonitis, and Peritoneal Carcinomatosis

Objective:To investigate the significance of computed tomography findings in diffuse malignant peritoneal mesothelioma(DMPeM),tuberculous peritonitis(TBP),and peritoneal carcinomatosis(PC)to differentiate the three diseases.Methods:The clinical manifestation and computed tomography scans of 147 patients with diffuse malignant peritoneal mesothelioma(n=60),tuberculous peritonitis(n=32),and peritoneal carcinomatosis(n=55)were retrospectively reviewed,while taking into account of ascites,pleural plaques,viscera infiltration;abnormalities in the peritoneum;involvement of the mesentery and omentum;as well as the presence and location of enlarged lymph nodes.Results:There was no significant difference among all three groups in terms of clinical manifestation,peritoneum,omentum,and mesentery involvement,ascites,as well as the presence and location of enlarged lymph nodes.The study found that 95%of DMPeM patients had been exposed to asbestos in the past.The patients showed significant differences in the following aspects:(1)irregular peritoneum thickening,caked omentum thickening,pleural plaques,visceral infiltration,and asbestos exposure were more common in peritoneal mesothelioma patients;(2)nodular peritoneum thickening and visceral metastasis were more common in patients with peritoneal carcinomatosis;(3)smooth peritoneal thickening,pleural effusion,and extraperitoneal tuberculosis were more common in patients with tuberculous peritonitis.Conclusion:A combination of computed tomography findings could improve our ability in differentiating the three diseases.

A Study on Clinical Characteristics and Magnetic Resonance Imaging Manifestations on Systemic Rosai-Dorfman Disease

Background： Rosai-Dorfman disease （RDD） is typically characterized by painless bilateral and symmetrical cervical lymphadenopathy, with associated fever and leukocytosis. The aim of the current study was to summarize the clinical features and imaging characteristics of RDD, in an effort to improve its diagnostic accuracy. Methods： The study was analyzed from 32 patients between January 2011 and December 2017; of these, 16 patients had pathologically diagnosed RDD, eight had pathologically diagnosed meningioma, and eight pathologically diagnosed lymphoma. All patients underwent computed tomography and magnetic resonance imaging （MRI）. Clinical features and imaging characteristics of RDD were analyzed retrospectively. The mean apparent diffusion coefficient （ADC） values of lesions at different sites were measured, and one-way analysis of variance and the least significant difference t-test were used to compare the differences between groups and draw receiver operating characteristic curves. The tumors were excised for biopsy and analyzed using immunohistochemistry. Results： The mean ADCs were （0.81 ± 0.10） × 10^-3mm^2/s for intercranial RDD, （0.73 ± 0.05） × 10^-3mm^2/s for nasopharyngeal RDD, （0.74 ± 0.11） × 10^-3mm2/s for bone RDD, and （0.71 ± 0.04） × 10^-3mm2/s for soft-tissue RDD. The optimum ADC to distinguish intracranial RDD from lymphoma was 0.79 × 10^-3mm2/s （62.5% sensitivity and 100% specificity） and to distinguish meningioma from intracranial RDD was 0.92 × 10^-3mm^2/s （62.5% sensitivity and 100% specificity）. Levels of C-reactive protein, erythrocyte sediment rate and D-dimer were significantly elevated （81%, 87%, and 75%, respectively）. On immunohistochemistry, RDD was positive for both S-100 and CD68 proteins but negative for CD1a. Conclusions： Conventional MRI, combined with diffusion-weighted imaging and ADC mapping, is an important diagnostic tool in evaluating RDD patients. An accurate diagnosis of RDD should consider the clinical features, imaging characteristics, and the pathological findings.

Relationship Between Clinical and Immunological Features with Magnetic Resonance Imaging Abnormalities in Female Patients with Neuropsychiatric Systemic Lupus Erythematosus

Background：Conventional magnetic resonance imaging （MRI） is the preferred neuroimaging method in the evaluation ofneuropsychiatric systemic lupus erythematosus （NPSLE）.The purpose of this study was to investigate the association between clinical and immunological features with MRI abnormalities in female patients with NPSLE,to screen for the value of conventional MRI in NPSLE.Methods：A total of 59 female NPSLE patients with conventional MRI examinations were enrolled in this retrospective study.All patients were classified into different groups according to MRI abnormalities.Both clinical and immunological features were compared between MRI abnormal and normal groups.One-way analysis of variance was used to compare the systemic lupus erythematosus disease activity index （SLEDAI） score for MRI abnormalities.Multivariate logistic regression analysis investigated the correlation between immunological features,neuropsychiatric manifestations,and MRI abnormalities.Results：Thirty-six NPSLE patients （61%） showed a variety of MRI abnormalities.There were statistically significant differences in SLEDAI scores （P 〈 0.001）,incidence of neurologic disorders （P =0.001）,levels of 24-h proteinuria （P =0.001） and immunoglobulin M （P =0.004）,and incidence of acute confusional state （P =0.002）,cerebrovascular disease （P =0.004）,and seizure disorder （P =0.028） between MRI abnormal and normal groups.In the MRI abnormal group,SLEDAI scores for cerebral atrophy （CA）,cortex involvement,and restricted diffusion （RD） were much higher than in the MRI normal group （P 〈 0.001,P =0.002,P =0.038,respectively）.Statistically significant positive correlations between seizure disorder and cortex involvement （odds ratio [OR] =14.90;95% confidence interval [CI],1.50-151.70;P =0.023） and cerebrovascular disease and infratentorial involvement （OR =10.00;95% CI,1.70-60.00;P =0.012） were found.Conclusions：MRI abnormalities in NPSLE,especially CA,cortex involvement,and RD might be markers of high systemic lupus erythematosus activity.Some MRI abnormalities might correspond to neuropsychiatric manifestations and might be helpful in understanding the pathophysiology of NPSLE.

Primary gastrointestinal lymphoma

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type.Although lymphoma can involve any part of the gastrointestinal tract,the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region.Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare.Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions.Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract,although recently the frequency of other forms has also increased in certain regions of the world.Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma,they are not specific,thus mandating histopathological analysis for its definitive diagnosis.There has been a tremendous leap in the diagnosis,staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.

Application of T2＊ measurement on gradient echo T2＊-weighted imaging in differential diagnosis of intracranial hemorrhage and calcification

Background Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis. The purpose of this study was to investigate the feasibility of T2＊ measurement on gradient echo （GRE） T2＊-weighted imaging （T2＊WI） in differential diagnosis of intracranial hemorrhage and calcification. Methods Thirty-eight hemorrhagic foci in 18 patients and 11 calcification foci in seven patients were included in this study. The diagnosis of hemorrhage and calcification was confirmed in all cases with enhanced T2＊ weighted angiography （ESWAN） magnetic resonance imaging （MRI） and CT respectively. The significance for the difference of T2＊ value between the central and peripheral areas of hemorrhage and calcification lesions was tested with univariate analysis of variance, Results The detection rate of GRE T2＊WI on intracranial hemorrhage was 1.9-fold higher than that of CT, especially for the hemorrhage in the brainstem and cerebellum. However, GRE T2＊WI was far less sensitive to calcification than CT. There was a significant difference in the T2＊ value between the central area of hemorrhage and calcification （P 〈0.001）, though no difference in the T2＊ value was obtained between the peripheral area of hemorrhage and calcification （P 〉0.05）. Conclusions Quantitative measurement of T2＊ value on GRE T2＊WI with a single MRI examination provides a fast, convenient, and effective means in differential diagnosis between intracranial hemorrhage and calcification, which may thus reduce the medical cost and save precious time for clinical management.

Primary esophageal lymphoma in immunocompetent patients:Two case reports and literature review

Primary lymphoma that involves the esophagus is very rare,with fewer than 30 cases reported in the Englishlanguage literature.Non-Hodgkin lymphoma accounts for most of the cases.Esophageal lymphomas have varied radiological appearances,which poses diagnostic difficulty.We report two cases of histopathologically confirmed primary diffuse large B-cell esophageal lymphoma and describe their radiological features,and briefly review the literature.

Beyond Antibiotics:Photo/Sonodynamic Approaches for Bacterial Theranostics

Rapid evolution and propagation of multidrug resistance among bacterial pathogens are outpacing the development of new antibiotics,but antimicrobial photodynamic therapy(aPDT)provides an excellent alternative.This treatment depends on the interaction between light and photoactivated sensitizer to generate reactive oxygen species(ROS),which are highly cytotoxic to induce apoptosis in virtually all microorganisms without resistance concern.When replacing light with low-frequency ultrasonic wave to activate sensitizer,a novel ultrasounddriven treatment emerges as antimicrobial sonodynamic therapy(aSDT).Recent advances in aPDT and aSDT reveal golden opportunities for the management of multidrug resistant bacterial infections,especially in the theranostic application where imaging diagnosis can be accomplished facilely with the inherent optical characteristics of sensitizers,and the generated ROS by aPDT/SDT cause broad-spectrum oxidative damage for sterilization.In this review,we systemically outline the mechanisms,targets,and current progress of aPDT/SDT for bacterial theranostic application.Furthermore,potential limitations and future perspectives are also highlighted.

Chronic stress causes protein kinase C epsilon-aldehyde dehydrogenase 2 signaling pathway perturbation in the rat hippocampus and prefrontal cortex,but not in the myocardium

Chronic stress is strongly associated with the occurrence and development of depression and cardiovascular disease.Stress can induce altered mitochondrial function and activation of apoptosis in the cardio-cerebral system.However,it is unknown whether the protein kinase C ε（PKCε）-aldehyde dehydrogenase 2（ALDH2） pathway is altered under chronic stress,and this study sought to address this question.A rat model of depression was established using a chronic unpredictable mild stress（CUMS） protocol.After experiencing CUMS for 4 weeks,the sucrose preference test and the forced swim test verified depressive-like behaviors.Enzyme linked immunosorbent assays showed that ALDH2 activity was decreased in the rat hippocampus and prefrontal cortex,but was not altered in the myocardium.Western blot assays demonstrated reduced levels of ALDH2 and PKCε,but increased levels of 4-hydroxy-2-nonenal（4 HNE） adducts.Caspase-3 expression did not obviously alter,but active forms of caspase-3 were increased in the hippocampus and prefrontal cortex.In the myocardium,expression of ALDH2,PKCε and 4 HNE adducts did not remarkably alter;while caspase-3 expression was reduced and the active forms of caspase-3 were upregulated.Pearson＇s correlation test demonstrated that expression of 4 HNE adducts was positively correlated with levels of the active forms of caspase-3 in the hippocampus and prefrontal cortex,but not in the myocardium.In conclusion,chronic stress can damage the PKCε-ALDH2 signaling pathway in the hippocampus and prefrontal cortex,but not in the myocardium.Moreover,4 HNE is associated with active forms of caspase-3 in the hippocampus and prefrontal cortex.