Objective:To review the risk of prostate cancer(PCa)in men with incidentally reported increased intraprostatic uptake at 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography(18F-FDG PET/CT)...Objective:To review the risk of prostate cancer(PCa)in men with incidentally reported increased intraprostatic uptake at 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography(18F-FDG PET/CT)ordered at Department of Urology,The Wesley Hospital,Brisbane,QLD,Australia for non-PCa related pathology.Methods:Retrospective analysis of consecutive men between August 2014 and August 2019 presenting to a single institution for 18F-FDG PET/CT for non-prostate related conditions was conducted.Men were classified as benign,indeterminate,or malignant depending of the results of prostate-specific antigen(PSA),PSA velocity,biopsy histopathology,and three-Tesla(3 T)multiparametric MRI(mpMRI)Prostate Imaging Reporting and Data System score,or gallium-68-prostate-specific membrane antigen(68Ga-PSMA)PET/CT results.Results:Three percent(273/9122)of men demonstrated 18F-FDG avidity within the prostate.Eighty-five percent(231/273)were further investigated,including with PSA tests(227/231,98.3%),3 T mpMRI(68/231,29.4%),68Ga-PSMA PET/CT(33/231,14.3%),and prostate biopsy(57/231,24.7%).Results were considered benign in 130/231(56.3%),indeterminate in 31/231(13.4%),and malignant in 70/231(30.3%).PCa was identified in 51/57(89.5%)of the men who proceeded to biopsy,including 26/27(96.3%)men with Prostate Imaging Reporting and Data System scores 4-5 mpMRI and six men with a positive 68Ga-PSMA PET/CT.The most common Gleason score on biopsy was greater than or equal to 4+5(14/51,27.5%).68Ga-PSMA PET/CT was concordant with the 18F-FDG findings in 26/33(78.8%).All 13 men with a positive concordant 18F-FDG,3 T mpMRI,and 68Ga-PSMA PET/CT had PCa on biopsy.There was no statistically significant difference in the 18F-FDG maximum standardized uptake value between the benign or malignant groups(5.7 vs.6.1;p=0.580).Conclusion:In this study,after an incidental finding of an avid intraprostatic lesion on 18F-FDG PET/CT,70 of the 231 cases(30.3%;0.8%of the entire cohort)had results consistent with PCa,most commonly as Gleason score greater than or equal to 4+5 disease.Unless there is limited life expectancy due to competing medical co-morbidity,men with an incidental finding of intraprostatic uptake on 18F-FDG should be further investigated using principles of PCa detection.展开更多
Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced geni...Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)after 5 years of further experience comprising>1000 scans.Intraobserver agreement was measured using Cohen's kappa.Sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's test.Results Ninety-six mpMRIp scans were included in our final analysis.Of the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions targeted.Moderate agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is moderate.Reduced sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.展开更多
The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magneti...The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging(f MRI)on the effects of acupuncture at Waiguan(SJ5)in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan(SJ5)and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient's sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus(BA39)/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe(BA11),right limbic lobe(BA30,35),and left frontal lobe(BA47),while the only deactivated area was the right parietal lobe(BA40).Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe(BA30).These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.展开更多
AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out usin...AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out using MEDLINE, EMBASE, CINAHL, Cochrane library databases, Google scholar and Pub Med until October 2014. Search terms were used in combination to yield articles on extramural venous invasion in rectal cancer. Outcome measures included prevalence and 5-year survival rates. These were graphically displayed using Forest plots. Statistical analysis of the data was carried out.RESULTS: Fourteen studies reported the prevalence of extramural venous invasion(EMVI) positive patients. Prevalence ranged from 9%-61%. The pooled prevalence of EMVI positivity was 26% [Random effects: Event rate 0.26(0.18, 0.36)]. Most studies showed that EMVI related to worse oncological outcomes. The pooled overall survival was 39.5% [Random effects: Event rate 0.395(0.29, 0.51)].CONCLUSION: Historically, there has been huge variation in the prevalence of EMVI through inconsistent reporting. However the presence of EMVI clearly leads to worse survival outcomes. As detection rates become more consistent, EMVI may be considered as part of risk-stratification in rectal cancer. Standardised histopathological definitions and the use of magnetic resonance imaging to identify EMVI will improve detection rates in the future.展开更多
Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. ...Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.展开更多
Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that...Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that is situated downstream of genomics,transcriptomics and proteomics.Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes.During the last decade,metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways.It is a powerful technique to improve our pathophysiological knowledge of various liver diseases.It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease.It can also assess therapeutic response or predict drug induced liver injury.Nevertheless,the usefulness of metabolomics is often not understood by clinicians,especially the concept of metabolomics profiling or fingerprinting.In the present work,after a concise description of the different techniques and processes used in metabolomics,we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies.We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical"routine".展开更多
AIM: To investigate gadolinium-ethoxybenzyldiethylenetriamine-pentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance imaging(MRI) of intraductal papillary mucinous neoplasms of the bile duct(IPMN-B). METHODS: The i...AIM: To investigate gadolinium-ethoxybenzyldiethylenetriamine-pentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance imaging(MRI) of intraductal papillary mucinous neoplasms of the bile duct(IPMN-B). METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography(CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented.RESULTS: Conventional imaging showed diffusedilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. GdEOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomographyCT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology. CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases.展开更多
Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers...Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers before and after acupuncture atTaichong (LR3) andTaixi (KI3) using resting-state functional magnetic resonance imaging. Fifteen healthy volunteers underwent resting-state functional magnetic resonance imaging of the brain 15 minutes before acupuncture, then received acupuncture atTaichong andTaixi using the nail-pressing needle insertion method, after which the needle was retained in place for 30 minutes. Fifteen minutes after withdrawal of the needle, the volunteers underwent a further session of resting-state functional magnetic res-onance imaging, which revealed that the amplitude of low-frequency lfuctuation, a measure of spontaneous neuronal activity, increased mainly in the cerebral occipital lobe and middle occipital gyrus (Brodmann area 18/19), inferior occipital gyrus (Brodmann area 18) and cuneus (Brodmann area 18), but decreased mainly in the gyrus rectus of the frontal lobe (Brodmann area 11), inferi-or frontal gyrus (Brodmann area 44) and the center of the posterior lobe of the cerebellum. The present ifndings indicate that acupuncture atTaichong andTaixi speciifcally promote blood lfow and activation in the brain areas related to vision, emotion and cognition, and inhibit brain areas related to emotion, attention, phonological and semantic processing, and memory.展开更多
Diagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease(IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentia...Diagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease(IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentially harmful cumulative levels of ionising radiation in their lifetime, increasing malignant potential in a population already at risk. In this review we explore the proportion of IBD patients exposed to high cumulative radiation doses, the risk factors associated with higher radiation exposures, and we compare conventional diagnostic imaging with newer radiation-free imaging techniques used in the evaluation of patients with IBD. While computed tomography(CT) performs well as an imaging modality for IBD, the effective radiation dose is considerably higher than other abdominal imaging modalities. It is increasingly recognised that CT imaging remains responsible for the majority of diagnostic medical radiation to which IBD patients are exposed. Magnetic resonance imaging(MRI) and small intestine contrast enhanced ultrasonography(SICUS) have now emerged as suitable radiation-free alternatives to CT imaging, with comparable diagnostic accuracy. The routine use of MRI and SICUS for the clinical evaluation of patients with known or suspected small bowel Crohn's disease is to be encouraged wherever possible. More provision is needed for out-of-hours radiation-free imaging modalities to reduce the need for CT.展开更多
Previous animal studies of cauda equina injury have primarily used rat models, which display significant differences from humans. Furthermore, most studies have focused on electrophysio- logical examination. To better...Previous animal studies of cauda equina injury have primarily used rat models, which display significant differences from humans. Furthermore, most studies have focused on electrophysio- logical examination. To better mimic the outcome after surgical repair of cauda equina injury, a novel animal model was established in the goat. Electrophysiological, histological and magnetic resonance imaging methods were used to evaluate the morphological and functional outcome after cauda equina injury and end-to-end suture. Our results demonstrate successful establish- ment of the goat experimental model of cauda equina injury. This novel model can provide detailed information on the nerve regenerative process following surgical repair of cauda equina injury.展开更多
The flexibility of dynamic community structure isadopted to analyze the depressive resting-state functionalmagnetic resonance imaging (rfMRI) signals in order toimprove the accuracy of evaluating depression treatmen...The flexibility of dynamic community structure isadopted to analyze the depressive resting-state functionalmagnetic resonance imaging (rfMRI) signals in order toimprove the accuracy of evaluating depression treatment. TherfMRI signals of each brain network were obtained by theindependent component correlation algorithm (ICA). Dynamicfunctional connections were computed with sliding windowsand L1 norm. Then, the connections were used to calculatethe dynamic community structure via the community-detectionalgorithm. The result of structure's community assignment hasthe general character with the brain activity changing overtime. The flexibility index is one of traits of dynamiccommunity structure, meaning the number of times a regionchanges. In this study, 16 patients who achieved clinicalremission joined the experiment and were scanned before andafter treatment. Pair permutation tests compare the differenceof six brain networks' flexibility between pre-therapy and post-treatment. The results show that the distribution of theflexibility values declines in a default network and cognitivecontrol network between we-therapy and post-treatmentpatients with statistical difference. Therefore, flexibility is asuitable approach to accurately evaluate the depressiontreatment effect.展开更多
The brain is highly plastic after stroke or epilepsy; however, there is a paucity of brain plasticity investigation after traumatic brain injury (TBI). This mini review summarizes the most recent evidence of brain p...The brain is highly plastic after stroke or epilepsy; however, there is a paucity of brain plasticity investigation after traumatic brain injury (TBI). This mini review summarizes the most recent evidence of brain plasticity in human TBI patients from the perspective of advanced magnetic resonance imaging. Similar to other forms of acquired brain injury, TBI patients also demonstrat- ed both structural reorganization as well as functional compensation by the recruitment of other brain regions. However, the large scale brain network alterations after TBI are still unknown, and the field is still short of proper means on how to guide the choice of TBI rehabilitation or treat- ment plan to promote brain plasticity. The authors also point out the new direction of brain plas- ticity investigation.展开更多
AIM: To identify the brain loci that process human biliary sensation. METHODS: In 6 patients (age range: 42-74 years; 4 men), who underwent percutaneous transhepatic biliary drainage (PTBD), the distal biliary tract w...AIM: To identify the brain loci that process human biliary sensation. METHODS: In 6 patients (age range: 42-74 years; 4 men), who underwent percutaneous transhepatic biliary drainage (PTBD), the distal biliary tract was stimulated by repeatedly inflating the balloon of the PTBD catheter so that it reached volumes that produced a definite painless sensation. The functional magnetic resonance imaging (fMRI) of the cortical response to biliary sensation was examined. RESULTS: Biliary balloon stimulation elicited activation of the insular cortex, prefrontal cortex, and somato- sensory cortex (P < 0.001). CONCLUSION: Biliary balloon stimulation evoked a cerebral cortical response detectable by fMRI.展开更多
Objective: To investigate the modulatory effect of acupuncture treatment on the resting-state functional connectivity of brain regions in migraine without aura (MWoA) patients. Methods: Twelve MWoA patients were t...Objective: To investigate the modulatory effect of acupuncture treatment on the resting-state functional connectivity of brain regions in migraine without aura (MWoA) patients. Methods: Twelve MWoA patients were treated with standard acupuncture treatment for 4 weeks. All MWoA patients received resting-state functional magnetic resonance imaging (fMRI) scanning before and after acupuncture treatment. Another 12 normal subjects matched in age and gender were recruited to serve as healthy controls. The changes of resting- state functional connectivity in MWoA patients before and after the acupuncture treatment and those with the healthy controls were compared. Results: Before acupuncture treatment, the MWoA patients had significantly decreased functional connectivity in certain brain regions within the frontal and temporal lobe when compared with the healthy controls. After acupuncture treatment, brain regions showing decreased functional connectivity revealed significant reduction in MWoA patients compared with before acupuncture treatment. Conclusions: Acupuncture treatment could increase the functional connectivity of brain regions in the intrinsic decreased brain networks in MWoA patients. The results provided further insights into the interpretation of neural mechanisms of acupuncture treatment for migraine.展开更多
Major depressive disorder(MDD) is a significant cause of morbidity and mortality worldwide,correlating with genetic susceptibility and environmental risk factors.Molecular,functional,and structural imaging approache...Major depressive disorder(MDD) is a significant cause of morbidity and mortality worldwide,correlating with genetic susceptibility and environmental risk factors.Molecular,functional,and structural imaging approaches have been increasingly used to detect neurobiological changes,analyze neurochemical correlates,and parse pathophysiological mechanisms underlying MDD.We reviewed recent neuroimaging publications on MDD in terms of molecular,functional,and structural alterations as detected mainly by magnetic resonance imaging(MRI) and positron emission tomography.Altered structure and function of brain regions involved in the cognitive control of affective state have been demonstrated.An abnormal default mode network,as revealed by resting-state functional MRI,is likely associated with aberrant metabolicand serotonergic function revealed by radionuclide imaging.Further multi-modal investigations are essential to clarify the characteristics of the cortical network and serotonergic system associated with behavioral and genetic variations in MDD.展开更多
Background: Lipid storage myopathy (LSM) is a genetically heterogeneous group with variable clinical phenotypes. Late-onset multiple acyl-coenzyme A dehydrogenation deficiency (MADD) is a rather common form of LS...Background: Lipid storage myopathy (LSM) is a genetically heterogeneous group with variable clinical phenotypes. Late-onset multiple acyl-coenzyme A dehydrogenation deficiency (MADD) is a rather common form of LSM in China. Diagnosis and clinical management of it remain challenging, especially without robust muscle biopsy result and genetic detection. As the noninvasion and convenience, muscle magnetic resonance imaging (MRI) is a helpful assistant, diagnostic tool for neuromuscular disorders. However, the disease-specific MRI patterns of muscle involved and its diagnostic value in late-onset MADD have not been systematic analyzed. Methods: We assessed the MRI pattern and fat infiltration degree of the lower limb muscles in 28 late-onset MADD patients, combined with detailed clinical features and gene spectrum. Fat infiltration degree of the thigh muscle was scored while that ofgluteus was described as obvious or not. Associated muscular atrophy was defined as obvious muscle bulk reduction. Results: The mean scores were significantly different among the anterior, medial, and posterior thigh muscle groups. The mean of fat infiltration scores on posterior thigh muscle group was significantly higher than either anterior or medial thigh muscle group (P 〈 0.00 l). Moreover, the mean score on medial thigh muscle group was significantly higher than that of anterior thigh muscle group (P 〈 0.01). About half of the patients displayed fat infiltration and atrophy in gluteus muscles. Of 28 patients, 12 exhibited atrophy in medial and/ or posterior thigh muscle groups, especially in posterior thigh muscle group. Muscle edema pattern was not found in all the patients. Conclusions: Late-onset MADD patients show a typical muscular imaging pattern of fat infiltration and atrophy on anterior, posterior, and medial thigh muscle groups, with major involvement of posterior thigh muscle group and gluteus muscles and a sparing involvement of anterior thigh compartment. Our findings also suggest that muscle MRI of lower limbs is a helpful tool in guiding clinical evaluation on late-onset MADD.展开更多
文摘Objective:To review the risk of prostate cancer(PCa)in men with incidentally reported increased intraprostatic uptake at 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography(18F-FDG PET/CT)ordered at Department of Urology,The Wesley Hospital,Brisbane,QLD,Australia for non-PCa related pathology.Methods:Retrospective analysis of consecutive men between August 2014 and August 2019 presenting to a single institution for 18F-FDG PET/CT for non-prostate related conditions was conducted.Men were classified as benign,indeterminate,or malignant depending of the results of prostate-specific antigen(PSA),PSA velocity,biopsy histopathology,and three-Tesla(3 T)multiparametric MRI(mpMRI)Prostate Imaging Reporting and Data System score,or gallium-68-prostate-specific membrane antigen(68Ga-PSMA)PET/CT results.Results:Three percent(273/9122)of men demonstrated 18F-FDG avidity within the prostate.Eighty-five percent(231/273)were further investigated,including with PSA tests(227/231,98.3%),3 T mpMRI(68/231,29.4%),68Ga-PSMA PET/CT(33/231,14.3%),and prostate biopsy(57/231,24.7%).Results were considered benign in 130/231(56.3%),indeterminate in 31/231(13.4%),and malignant in 70/231(30.3%).PCa was identified in 51/57(89.5%)of the men who proceeded to biopsy,including 26/27(96.3%)men with Prostate Imaging Reporting and Data System scores 4-5 mpMRI and six men with a positive 68Ga-PSMA PET/CT.The most common Gleason score on biopsy was greater than or equal to 4+5(14/51,27.5%).68Ga-PSMA PET/CT was concordant with the 18F-FDG findings in 26/33(78.8%).All 13 men with a positive concordant 18F-FDG,3 T mpMRI,and 68Ga-PSMA PET/CT had PCa on biopsy.There was no statistically significant difference in the 18F-FDG maximum standardized uptake value between the benign or malignant groups(5.7 vs.6.1;p=0.580).Conclusion:In this study,after an incidental finding of an avid intraprostatic lesion on 18F-FDG PET/CT,70 of the 231 cases(30.3%;0.8%of the entire cohort)had results consistent with PCa,most commonly as Gleason score greater than or equal to 4+5 disease.Unless there is limited life expectancy due to competing medical co-morbidity,men with an incidental finding of intraprostatic uptake on 18F-FDG should be further investigated using principles of PCa detection.
基金This research has been kindly supported by a grant from the St Vincent's Research Endowment Fund(approval number 55.2014).
文摘Objective To measure the intraobserver concordance of an experienced genitourinary radiologist reporting of multiparametric magnetic resonance imaging of the prostate(mpMRIp)scans over time.Methods An experienced genitourinary radiologist re-reported his original 100 consecutive mpMRIp scans using Prostate Imaging-Reporting and Data System version 2(PI-RADS v2)after 5 years of further experience comprising>1000 scans.Intraobserver agreement was measured using Cohen's kappa.Sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV),and accuracy were calculated,and comparison of sensitivity was performed using McNemar's test.Results Ninety-six mpMRIp scans were included in our final analysis.Of the 96 patients,53(55.2%)patients underwent subsequent biopsy(n=43)or prostatectomy(n=15),with 73 lesions targeted.Moderate agreement(Cohen's kappa 0.55)was seen in the number of lesions identified at initial reporting and on re-reading(81 vs.39 total lesions;and 71 vs.37 number of PI-RADS≥3 lesions).For clinically significant prostate cancer,re-reading demonstrated an increase in specificity(from 43%to 89%)and PPV(from 62%to 87%),but a decrease in sensitivity(from 94%to 72%,p=0.01)and NPV(from 89%to 77%).Conclusion The intraobserver agreement for a novice to experienced radiologist reporting mpMRIp using PI-RADS v2 is moderate.Reduced sensitivity is off-set by improved specificity and PPV,which validate mpMRIp as a gold standard for prebiopsy screening.
基金supported by the National Key Basic Research and Development Plan of China(973 Program),No.2006CB504505,2012CB518504the"University Students Innovation Experiment Project"in Guangdong Province of China,No.1212112038
文摘The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging(f MRI)on the effects of acupuncture at Waiguan(SJ5)in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan(SJ5)and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient's sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus(BA39)/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe(BA11),right limbic lobe(BA30,35),and left frontal lobe(BA47),while the only deactivated area was the right parietal lobe(BA40).Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe(BA30).These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.
文摘AIM: To systematically review the survival outcomes relating to extramural venous invasion in rectal cancer.METHODS: A systematic review was conducted using PRISMA guidelines. An electronic search was carried out using MEDLINE, EMBASE, CINAHL, Cochrane library databases, Google scholar and Pub Med until October 2014. Search terms were used in combination to yield articles on extramural venous invasion in rectal cancer. Outcome measures included prevalence and 5-year survival rates. These were graphically displayed using Forest plots. Statistical analysis of the data was carried out.RESULTS: Fourteen studies reported the prevalence of extramural venous invasion(EMVI) positive patients. Prevalence ranged from 9%-61%. The pooled prevalence of EMVI positivity was 26% [Random effects: Event rate 0.26(0.18, 0.36)]. Most studies showed that EMVI related to worse oncological outcomes. The pooled overall survival was 39.5% [Random effects: Event rate 0.395(0.29, 0.51)].CONCLUSION: Historically, there has been huge variation in the prevalence of EMVI through inconsistent reporting. However the presence of EMVI clearly leads to worse survival outcomes. As detection rates become more consistent, EMVI may be considered as part of risk-stratification in rectal cancer. Standardised histopathological definitions and the use of magnetic resonance imaging to identify EMVI will improve detection rates in the future.
文摘Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.
文摘Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification.It is an"omics"technique that is situated downstream of genomics,transcriptomics and proteomics.Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes.During the last decade,metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways.It is a powerful technique to improve our pathophysiological knowledge of various liver diseases.It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease.It can also assess therapeutic response or predict drug induced liver injury.Nevertheless,the usefulness of metabolomics is often not understood by clinicians,especially the concept of metabolomics profiling or fingerprinting.In the present work,after a concise description of the different techniques and processes used in metabolomics,we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies.We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical"routine".
基金Supported by National Natural Science Foundation of China,No.81171388Ministry of Health Research Foundation of China(in part),No.WKJ2011-2-004
文摘AIM: To investigate gadolinium-ethoxybenzyldiethylenetriamine-pentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance imaging(MRI) of intraductal papillary mucinous neoplasms of the bile duct(IPMN-B). METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography(CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented.RESULTS: Conventional imaging showed diffusedilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. GdEOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomographyCT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology. CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases.
基金supported by a grant from the National Key Basic Research and Development Project(973 Program),No.2012CB518504a grant from the National Level Undergraduate Student Innovation Venture Training Project of Local Colleges,No.201212121048a grant from the ThreeStage Key Subject Construction Project of Guangdong Province of China(211 Project),No.(2009)431
文摘Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers before and after acupuncture atTaichong (LR3) andTaixi (KI3) using resting-state functional magnetic resonance imaging. Fifteen healthy volunteers underwent resting-state functional magnetic resonance imaging of the brain 15 minutes before acupuncture, then received acupuncture atTaichong andTaixi using the nail-pressing needle insertion method, after which the needle was retained in place for 30 minutes. Fifteen minutes after withdrawal of the needle, the volunteers underwent a further session of resting-state functional magnetic res-onance imaging, which revealed that the amplitude of low-frequency lfuctuation, a measure of spontaneous neuronal activity, increased mainly in the cerebral occipital lobe and middle occipital gyrus (Brodmann area 18/19), inferior occipital gyrus (Brodmann area 18) and cuneus (Brodmann area 18), but decreased mainly in the gyrus rectus of the frontal lobe (Brodmann area 11), inferi-or frontal gyrus (Brodmann area 44) and the center of the posterior lobe of the cerebellum. The present ifndings indicate that acupuncture atTaichong andTaixi speciifcally promote blood lfow and activation in the brain areas related to vision, emotion and cognition, and inhibit brain areas related to emotion, attention, phonological and semantic processing, and memory.
文摘Diagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease(IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentially harmful cumulative levels of ionising radiation in their lifetime, increasing malignant potential in a population already at risk. In this review we explore the proportion of IBD patients exposed to high cumulative radiation doses, the risk factors associated with higher radiation exposures, and we compare conventional diagnostic imaging with newer radiation-free imaging techniques used in the evaluation of patients with IBD. While computed tomography(CT) performs well as an imaging modality for IBD, the effective radiation dose is considerably higher than other abdominal imaging modalities. It is increasingly recognised that CT imaging remains responsible for the majority of diagnostic medical radiation to which IBD patients are exposed. Magnetic resonance imaging(MRI) and small intestine contrast enhanced ultrasonography(SICUS) have now emerged as suitable radiation-free alternatives to CT imaging, with comparable diagnostic accuracy. The routine use of MRI and SICUS for the clinical evaluation of patients with known or suspected small bowel Crohn's disease is to be encouraged wherever possible. More provision is needed for out-of-hours radiation-free imaging modalities to reduce the need for CT.
基金supported by grants from the National Program on Key Basic Research Project of China(973 Program),No.2014CB542200Program for Innovative Research Team in University of Ministry of Education of China,No.IRT1201+2 种基金the National Natural Science Foundation of China,No.31271284,31171150,81171146,30971526,31040043,31371210,81372044,31471144Program for New Century Excellent Talents in University of Ministry of Education of China,No.BMU20110270the Natural Science Foundation of Beijing of China,No.7142164
文摘Previous animal studies of cauda equina injury have primarily used rat models, which display significant differences from humans. Furthermore, most studies have focused on electrophysio- logical examination. To better mimic the outcome after surgical repair of cauda equina injury, a novel animal model was established in the goat. Electrophysiological, histological and magnetic resonance imaging methods were used to evaluate the morphological and functional outcome after cauda equina injury and end-to-end suture. Our results demonstrate successful establish- ment of the goat experimental model of cauda equina injury. This novel model can provide detailed information on the nerve regenerative process following surgical repair of cauda equina injury.
基金The National High Technology Research and Development Program of China(863 program)(No.2015AA020509)the National Natural Science Foundation of China(No.81571639,81371522,61372032)
文摘The flexibility of dynamic community structure isadopted to analyze the depressive resting-state functionalmagnetic resonance imaging (rfMRI) signals in order toimprove the accuracy of evaluating depression treatment. TherfMRI signals of each brain network were obtained by theindependent component correlation algorithm (ICA). Dynamicfunctional connections were computed with sliding windowsand L1 norm. Then, the connections were used to calculatethe dynamic community structure via the community-detectionalgorithm. The result of structure's community assignment hasthe general character with the brain activity changing overtime. The flexibility index is one of traits of dynamiccommunity structure, meaning the number of times a regionchanges. In this study, 16 patients who achieved clinicalremission joined the experiment and were scanned before andafter treatment. Pair permutation tests compare the differenceof six brain networks' flexibility between pre-therapy and post-treatment. The results show that the distribution of theflexibility values declines in a default network and cognitivecontrol network between we-therapy and post-treatmentpatients with statistical difference. Therefore, flexibility is asuitable approach to accurately evaluate the depressiontreatment effect.
基金supported by the Department of Defense,grant number W81XWH-11-1-0493
文摘The brain is highly plastic after stroke or epilepsy; however, there is a paucity of brain plasticity investigation after traumatic brain injury (TBI). This mini review summarizes the most recent evidence of brain plasticity in human TBI patients from the perspective of advanced magnetic resonance imaging. Similar to other forms of acquired brain injury, TBI patients also demonstrat- ed both structural reorganization as well as functional compensation by the recruitment of other brain regions. However, the large scale brain network alterations after TBI are still unknown, and the field is still short of proper means on how to guide the choice of TBI rehabilitation or treat- ment plan to promote brain plasticity. The authors also point out the new direction of brain plas- ticity investigation.
文摘AIM: To identify the brain loci that process human biliary sensation. METHODS: In 6 patients (age range: 42-74 years; 4 men), who underwent percutaneous transhepatic biliary drainage (PTBD), the distal biliary tract was stimulated by repeatedly inflating the balloon of the PTBD catheter so that it reached volumes that produced a definite painless sensation. The functional magnetic resonance imaging (fMRI) of the cortical response to biliary sensation was examined. RESULTS: Biliary balloon stimulation elicited activation of the insular cortex, prefrontal cortex, and somato- sensory cortex (P < 0.001). CONCLUSION: Biliary balloon stimulation evoked a cerebral cortical response detectable by fMRI.
基金Supported by the National Natural Science Foundation of China(No.81473667)Beijing Young Talent Program of Beijing Education Committee(No.YETP0823)the Research Funds of Beijing University of Chinese Medicine(No.2013-JYBZZJS-148,2014-JYBZZ-XS-142)
文摘Objective: To investigate the modulatory effect of acupuncture treatment on the resting-state functional connectivity of brain regions in migraine without aura (MWoA) patients. Methods: Twelve MWoA patients were treated with standard acupuncture treatment for 4 weeks. All MWoA patients received resting-state functional magnetic resonance imaging (fMRI) scanning before and after acupuncture treatment. Another 12 normal subjects matched in age and gender were recruited to serve as healthy controls. The changes of resting- state functional connectivity in MWoA patients before and after the acupuncture treatment and those with the healthy controls were compared. Results: Before acupuncture treatment, the MWoA patients had significantly decreased functional connectivity in certain brain regions within the frontal and temporal lobe when compared with the healthy controls. After acupuncture treatment, brain regions showing decreased functional connectivity revealed significant reduction in MWoA patients compared with before acupuncture treatment. Conclusions: Acupuncture treatment could increase the functional connectivity of brain regions in the intrinsic decreased brain networks in MWoA patients. The results provided further insights into the interpretation of neural mechanisms of acupuncture treatment for migraine.
基金supported by the National Natural Science Foundation of China (81425015 and 81271601)the International S&T Cooperation Program of China (2015DFG32740)the Zhejiang Provincial Natural Science Foundation of China (LR13H180001)
文摘Major depressive disorder(MDD) is a significant cause of morbidity and mortality worldwide,correlating with genetic susceptibility and environmental risk factors.Molecular,functional,and structural imaging approaches have been increasingly used to detect neurobiological changes,analyze neurochemical correlates,and parse pathophysiological mechanisms underlying MDD.We reviewed recent neuroimaging publications on MDD in terms of molecular,functional,and structural alterations as detected mainly by magnetic resonance imaging(MRI) and positron emission tomography.Altered structure and function of brain regions involved in the cognitive control of affective state have been demonstrated.An abnormal default mode network,as revealed by resting-state functional MRI,is likely associated with aberrant metabolicand serotonergic function revealed by radionuclide imaging.Further multi-modal investigations are essential to clarify the characteristics of the cortical network and serotonergic system associated with behavioral and genetic variations in MDD.
基金grants from the National Natural Science Foundation of China,the National Key Clinical Specialty Discipline Construction Program,and Fujian Key Clinical Specialty Discipline Construction Program
文摘Background: Lipid storage myopathy (LSM) is a genetically heterogeneous group with variable clinical phenotypes. Late-onset multiple acyl-coenzyme A dehydrogenation deficiency (MADD) is a rather common form of LSM in China. Diagnosis and clinical management of it remain challenging, especially without robust muscle biopsy result and genetic detection. As the noninvasion and convenience, muscle magnetic resonance imaging (MRI) is a helpful assistant, diagnostic tool for neuromuscular disorders. However, the disease-specific MRI patterns of muscle involved and its diagnostic value in late-onset MADD have not been systematic analyzed. Methods: We assessed the MRI pattern and fat infiltration degree of the lower limb muscles in 28 late-onset MADD patients, combined with detailed clinical features and gene spectrum. Fat infiltration degree of the thigh muscle was scored while that ofgluteus was described as obvious or not. Associated muscular atrophy was defined as obvious muscle bulk reduction. Results: The mean scores were significantly different among the anterior, medial, and posterior thigh muscle groups. The mean of fat infiltration scores on posterior thigh muscle group was significantly higher than either anterior or medial thigh muscle group (P 〈 0.00 l). Moreover, the mean score on medial thigh muscle group was significantly higher than that of anterior thigh muscle group (P 〈 0.01). About half of the patients displayed fat infiltration and atrophy in gluteus muscles. Of 28 patients, 12 exhibited atrophy in medial and/ or posterior thigh muscle groups, especially in posterior thigh muscle group. Muscle edema pattern was not found in all the patients. Conclusions: Late-onset MADD patients show a typical muscular imaging pattern of fat infiltration and atrophy on anterior, posterior, and medial thigh muscle groups, with major involvement of posterior thigh muscle group and gluteus muscles and a sparing involvement of anterior thigh compartment. Our findings also suggest that muscle MRI of lower limbs is a helpful tool in guiding clinical evaluation on late-onset MADD.