Multimodality imaging of ovarian cystic lesions: Review with an imaging based algorithmic approach

Ovarian cystic masses include a spectrum of benign, borderline and high grade malignant neoplasms. Imaging plays a crucial role in characterization and pretreatment planning of incidentally detected or suspected adnexal masses, as diagnosis of ovarian malignancy at an early stage is correlated with a better prognosis. Knowledge of differential diagnosis, imaging features, management trends and an algorithmic approach of such lesions is important for optimal clinical management. This article illustrates a multi-modality approach in the diagnosis of a spectrum of ovarian cystic masses and also proposes an algorithmic approach for the diagnosis of these lesions.

Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach

BACKGROUND:Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma(HCC),a majority of patients are unable to undergo surgical resection due to various tumor and patient factors.Radiofrequency ablation(RFA)has mostly been used as a therapeutic alternative to resection for treating HCC.The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous approach.METHODS:Eight patients(male,seven;age,49-67 years) with 8 HCCs in difficult locations were treated by intraoperative RFA.Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound(US)guided percutaneous RFA.The locations of the tumors were hepatic dome in six patients,posterior subcapsule in one,and caudate lobe in one.The tumor size was 2.0 to 6.4 cm(mean,3.9 cm).Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes.Tumor resection was performed in six patients.One month later,treatment response was assessed by contrast material-enhanced computed tomography(CT).CT studies were performed every 2 or 3 months after RFA.RESULTS:RFA was technically successful in all tumors,and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement.One pneumothorax occurred.After a median follow-up of 18 months(range,6-30 months),no tumors showed local progression.During the follow-up period,four new recurrent tumors were observed in three patients.Four patients were alive at the time of this report and the other four died of hepatorenal syndrome,liver failure,and progression of new recurrent tumors.CONCLUSION:Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum

In the new era of functional magnetic resonance imaging(MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, "do not touch lesions" could be identified with the associated impact in the management of those patients. One of the hotspots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival.Therefore, in this review we will analyze the current functional imaging techniques available(18 F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.

Sex, ApoE4 and Alzheimer's disease: rethinking drug discovery in the era of precision medicine

Alzheimer's disease(AD) is the most common cause of dementia and presents with an insidious onset and long prodromal period. Despite billions spent on clinical trials and decades of research, there are currently no disease modifying therapies approved for AD.

18F-氟脱氧葡萄糖的摄取作为原发性宫颈癌放疗后的预后指标

Purpose. We evaluated the prognostic significance of tumor metabolic activity on pretreatment positron emission tomography using the glucose analog F- 18 fluorodeoxyglucose (FDG- PET) in patients with carcinoma of the cervix undergoing radiotherapy with or without concurrent chemotherapy. Methods. We studied 96 consecutive patients who underwent FDG- PET prior to initiation of radiotherapy with or without concurrent chemotherapy for carcinoma of the cervix. Pretreatment FDG uptake of the primary tumor was assessed with the semiquantitative standardized uptake value (SUV) and correlated with di-sease- free and overall survival. Survival was estimated by the Kaplan- Meier method. Univariate and multivariate analyses were performed with the logistic likelihood ratio test and the Cox proportional hazards model, respectively. Results. Five-year disease- free survivals in patients with maximal SUV < 10.2 and ≥ 10.2 were 71% and 52% (P = 0.0289)- respectively, while overall survivals were 72% and 69% (P = 0.4), respectively. On multivariate analysis, lymph node metastasis on FDG- PET was found to be predictive of disease- free survival (P < 0.0001). Both the SUV for FDG and FIGO Stage I disease were found to be marginally predictive of disease- free survival (P = 0.055 and P = 0.058, respectively). Conclusions. FDG uptake within primary cervical cancer, as measured by SUV, is predictive of disease- free survival in patients undergoing radiotherapy for cervical cancer. High FDG uptake may be useful in identifying patients who may require more aggressive initial therapy.

Predicting Coronary Plaque Morphology Changes Based on Multimodality FSI Models Using Follow-Up IVUS and OCT Data

Background Current bottleneck of patient-specific coronary plaque model construction is the resolution of in vivo medical imaging.The threshold of cap thickness of vulnerable coronary plaques is 65 microns,while the resolution of in vivo coronary intravascular ultrasound(IVUS)images is 150-200 microns,which is not enough to identify vulnerable plaques with thin caps and construct accurate biomechanical plaque models.Optical coherence tomography(OCT)with a 15-20μm resolution has the capacity to identify thin fibrous cap.IVUS and OCT images could complement each other and provide for more accurate plaque morphology,especially,fibrous cap thickness measurements.A modeling approach combining IVUS and OCT was introduced in our previous publication for cap thickness quantification and more accurate cap stress/strain calculations.In this paper,patient baseline and follow-up IVUS and OCT data were acquired and multimodality image-based Fluidstructure interaction(FSI)models combining 3D IVUS,OCT,angiography were constructed to better quantify human coronary atherosclerotic plaque morphology and plaque stress/strain conditions and investigate the relationship of plaque vulnerability and morphological and mechanical factors.Methods Baseline and 10-Month follow-up in vivo IVUS and OCT coronary plaque data were acquired from one patient with informed consent obtained.Co-registration and segmentation of baseline and follow-up IVUS and OCT images were performed for modeling use.Baseline and follow-up 3D FSI models based on IVUS and OCT were constructed to simulate the mechanical factors which integrating plaque morphology were employed to predict plaque vulnerability.These 3D models were solved by ADINA(ADINA R&D,Watertown,MA,USA).The quantitative indices of cap thickness,lipid percentage were classified according to histological literatures and denoted as Cap Index and Lipid Index.Cap Index,Lipid Index and Morphological Plaque Vulnerability Index(MPVI)were chosen to quantify plaque vulnerability,respectively.Random forest(RF)which was based 13 extracted features including morphological and mechanical factors was used for plaque vulnerability classification and prediction.Over sampling scheme and a 5-fold crossvalidation procedure was employed in all 45 slices for training and testing sets.Single and all different combinations of morphological and mechanical risk factors were used for plaque progression prediction.Results When Cap Index was used as the measurement,minimum cap thickness(MCT)was the best single predictor which area under curve(AUC)is 0.782 0;the combination of MCT,critical plaque wall strain(CPWSn),critical wall shear stress(CWSS)and cap wall shear stress(CapWSS)was the best predictor with ACU=0.868 6.When Lipid Index was used as the measurement,the lipid percentage(LP)was the best single predictor which AUC value is 0.857 8;the combination of Mean cap thickness(MeanCT),LP,CWSS and cap plaque wall stress(CapPWS)and was the best predictor with ACU=0.9821.When MPVI was used as the measurement,MCT was the best single predictor which AUC value is 0.782 9;the combination of MCT,LP,plaque area(PA),CPWSn and CapWSS was the best predictor with ACU=0.872 9.Conclusions Combinations of morphological and mechanical risk factors had higher prediction accuracy,compared to the prediction of single factors and other combination of morphological factors.

血浆胰岛素和血糖对1型糖尿病患者心肌血流的影响

OBJECTIVES: The objective of this study was to determine the impact of insulin and glucose on myocardial vasodilator function in patients with type 1 diabetes mellitus(T1DM). BACKGROUND: The relative importance of plasma insulin and glucose levels on the abnormal vasodilator function observed in T1DM is unknown. METHODS: Twenty T1DM patients underwent positron emission tomography studies to measure myocardial blood flow(MBF)(in ml/g/min) at rest(MBFr) and during adenosine(MBFa), both under baseline metabolic conditions and then during either hyperinsuline-miceuglycemic clamp(HE)(n=10; 40±9 years, 8 female subjects, hemoglobin A1c HbA1c 7.8±1.1%) or hyperinsulinemic-hyperglycemic clamp(HH)(n=10; 44±12 years, 8 female subjects, hemoglobin A1c 7.7±0.6%). RESULTS: Both groups showed similar MBFr and MBFa under baseline metabolic conditions(p=NS). Compared with baseline conditions, MBFr increased in the HH group(p< 0.005), whereas it did not change in the HE group. Compared with baseline conditions, MBFa decreased in the HH group(p< 0.05) but did not change in the HE group. Myocardial perfusion reserve(MPR)(MBFa /MBFr) was similar between the HE and HH groups at baseline(p=NS). During clamp, MPR tended to decrease in the HH group(p< 0.1) but did not change in the HE group(p=NS) when compared with baseline conditions. However, during the clamp MPR was significantly lower in the HH group when compared with the HE group(p< 0.0001). CONCLUSIONS: In the short term, hyperglycemia has a deleterious effect on myocardial vasodilator function, which outweighs the beneficial effect of hyperinsulinemia.

Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital

Background:According to the World Health Organization,China is one of 22 countries with serious tuberculosis(TB)infections and one of the 27 countries with serious multidrug-resistant TB strains.Despite the decline of tuberculosis in the overall population,healthcare workers(HCWs)are still at a high risk of infection.Compared with high-income countries,the TB prevalence among HCWs is higher in low-and middle-income countries.Low-dose computed tomography(LDCT)is becoming more popular due to its superior sensitivity and lower radiation dose.However,there have been no reports about active pulmonary tuberculosis(PTB)among HCWs as assessed with LDCT.The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers.Methods:This study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015.Low-dose lung CT examinations were performed in all cases.The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher’s exact test.Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test.Analyses of active PTB were performed according to different ages,numbers of years on the job,and the risks of the working areas.Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses,and the sensitivity and positive predictive value were calculated.Results:A total of 1012 participants were included in this study.During the 4-year period of medical examinations,active PTB was found in 19 cases,and inactive PTB was found in 109 cases.The prevalence of active PTB in the participants was 1.24%,0.67%,0.81%,and 0.53%for years 2012 to 2015.The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%,0.41%,0.54%,and 0.26%.Most HCWs with active TB(78.9%,15/19)worked in the high-risk areas of the hospital.There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas(odds ratio[OR],14.415;95%confidence interval(CI):4.733-43.896).Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud,cavity,fibrous shadow,and calcification signs exhibited significant differences(P=0.000,0.021,0.001,and 0.024,respectively).Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis,whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis.Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100%and 86.4%,respectively.Conclusions:Healthcare workers in tuberculosis hospitals are a high-risk group for active PTB.Yearly LDCT examinations of such high-risk groups are feasible and necessary.

Ultrasmall,elementary and highly translational nanoparticle X-ray contrast media from amphiphilic iodinated statistical copolymers

To expand the single-dose duration over which noninvasive clinical and preclinical cancer imaging can be conducted with high sensitivity,and well-defined spatial and temporal resolutions,a facile strategy to prepare ultrasmall nanoparticulate X-ray contrast media(nano-XRCM)as dual-modality imaging agents for positron emission tomography(PET)and computed tomography(CT)has been established.Synthesized from controlled copolymerization of triiodobenzoyl ethyl acrylate and oligo(ethylene oxide)acrylate monomers,the amphiphilic statistical iodocopolymers(ICPs)could directly dissolve in water to afford thermodynamically stable solutions with high aqueous iodine concentrations(>140 mg iodine/mL water)and comparable viscosities to conventional small molecule XRCM.The formation of ultrasmall iodinated nanoparticles with hydrodynamic diameters of ca.10 nm in water was confirmed by dynamic and static light scattering techniques.In a breast cancer mouse model,in vivo biodistribution studies revealed that the64Cu-chelator-functionalized iodinated nano-XRCM exhibited extended blood residency and higher tumor accumulation compared to typical small molecule imaging agents.PET/CT imaging of tumor over 3 days showed good correlation between PET and CT signals,while CT imaging allowed continuous observation of tumor retention even after 10 days post-injection,enabling longitudinal monitoring of tumor retention for imaging or potentially therapeutic effect after a single administration of nano-XRCM.

MRI,^18F—FDG PET／CT及PET／MR成像评估妇科肿瘤

MRI和^18F-脱氧葡萄糖（FDG）PET／CT在妇科癌症患者的诊疗中扮演着核心和互补角色。由于治疗通常需要联合手术、放疗以及化疗，因此成像对病情分期和评估预后非常重要。该文综述了运用上述2种成像模式在早期评估3种常见妇科肿瘤（宫颈癌、子宫内膜癌和卵巢上皮肿瘤）中的应用。重点提出了影响治疗的影像特征，以及2种成像方式的相对优势和不足。影像评估先期治疗后肿瘤复发以及后续姑息治疗方法的选择。并对MRI和PET中较新的功能和分子技术进行效果评估。最后，该文还介绍PET／MR成像的初期经验，PET／MR是一种新型技术，很有潜力成为个体化妇科肿瘤治疗方案制订的重要方法。

肺PET图像的定量分析:挑战和机遇

数百万人受呼吸系统疾病的影响,导致巨大的全球性健康困扰。由于目前对导致呼吸系统疾病发展和进展的潜在机制认识不足,治疗选择仍然有限。为克服此局限和理解相关分子变化,将无创影像技术如PET和SPECT用于探索生物标志物,其中18F-脱氧葡萄糖(FDG)PET显像的研究最多。由于肺内组织、气体、血液和水的构成比变异,定量分析肺的分子影像数据仍具挑战性。这些成分的比例随着肺部疾病的不同而不同,因此有不同的定量分析方法来显示这种变化,但迄今为止还没有开发出对数据标准化的方法。该文回顾了肺部疾病中18F-FDG PET定量分析方法的数据,聚焦于解释肺内成分变化的方法,解读衍生参数。分析的疾病包括急性呼吸窘迫综合征、慢性阻塞性肺疾病、肺间质性疾病如特发性肺纤维化。基于对既往文献、进行中的研究以及作者间讨论的回顾,作者提出了建议性的注意事项,以协助解读从这些方法及未来研究设计中衍生的参数。

动脉瘤性蛛网膜下腔出血患者出血后脑血管痉挛的介入治疗

本临床实践标准述及动脉瘤性蛛网膜下腔出血患者出血后脑血管痉挛（post—hemorrhagiccerebralvasospasm,PHCV）的介入治疗。这些结论基于神经介入外科学学会的标准委员会的评估，包括使用由美国心脏协会卒中委员会和牛津大学循证医学中心提出的循证医学指南进行的文献回顾。特别关注现有介入治疗方法的安全性和有效性，包括腔内球囊血管成形术（transluminalballoonangioplasty，TBA）和动脉内血管扩张药物输注治疗（intra-arterialvasodilatorinfusiontherapy，IAVT）。评估结果显示，这些侵袭性介入治疗可能有益，并可考虑用于PHCV，如伴有脑缺血症状和最佳的药物治疗无效的患者的治疗。概括起来，IAVT对累及近端和（或）远端颅内脑循环的PHCV可能有益，而TBA则可能对累及近端颅内脑循环的PHCV有益。评估结果显示，对于上述适应证，根据美国心脏协会指南可将TBA和IAVT归为IIb级推荐和B级证据，根据牛津大学循证医学中心指南则可归为4级推荐和C级证据。

颅内囊性脑动脉瘤血管内治疗的报道标准

背景和目的本文旨在为颅内脑动脉瘤的放射学评价和血管内治疗的报道标准、术语和书面定义提供共识性推荐意见。这些标准旨在设计临床试验，为患者的合理选择和分层提供统一的定义，并且允许对报道的数据进行分析和汇总分析。方法本文是由技术评价委员会、神经介入外科学会、介入放射学学会、美国神经外科医师协会和神经外科医师大会的脑血管神经外科联合分会以及美国神经病学学会卒中和介入神经病学分会组成的联合写作组起草完成的。对1991年1月-2007年12月美国国立医学图书馆文献数据库（PubMed）进行计算机检索，以确定已发表的涉及脑动脉瘤的评价和血管内治疗的脑血管介入治疗数据，以此作为质量评价的基准。我们设法确定那些可能影响操作成功和并发症风险的相关危险因素。本文针对脑动脉瘤血管内治疗临床试验设计方面的重要因素，提供了各种临床和技术方面的基本原则。本指南还包含了对这类临床试验统一报道标准的建议。这些定义和标准主要用于研究目的；不过，它们对于临床实践也应有所帮助，并且适用于所有出版物。结论脑动脉瘤的评价和治疗常常涉及多个医学专业。为制定破裂和未破裂脑动脉瘤的临床处理指南，美国心脏协会最近发辰的综述已对相关医学文献进行了回顾。尽管努力综合了脑动脉瘤评价和治疗方面的现有认识，但在以研究和报道为目的的术语和定义方面仍存在明显的不一致性。这些可操作的定义是由一个多学科写作组一致选择的，用来使涉及脑动脉瘤的临床试验和观察性研究中的影像学相关报道一致。这些定义应有助于不同组织发表能够直接进行比较的研究结果。

血管成形术和支架辅助血管成形术治疗颅内动脉粥样硬化的报道标准

背景和目的颅内动脉粥样硬化可导致众多患者发生缺血性卒中。过去10年里的技术发展使颅内动脉粥样硬化狭窄的血管内治疗成为可能。因颅内动脉粥样硬化狭窄而接受血管成形术或支架辅助血管成形术的患者数量不断增加。鉴于在对血管成形术或支架辅助血管成形术治疗颅内动脉粥样硬化狭窄或闭塞的临床和放射学评价、技术和转归进行报道时，尚缺乏普遍接受的定义，本文的目的是为其报道标准、术语和书面定义提供共识性推荐意见。报道摘要本文是由技术评价委员会、神经介入外科学会、介入放射学学会、美国神经外科医师协会和神经外科医师大会的脑血管神经外科联合分会以及美国神经病学学会卒中和介入神经病学分会组成的联合写作组起草完成的。对1997年1月—2007年12月美国国立医学图书馆文献数据库（PubMed）进行计算机检索，以确定已发表的涉及狭窄性颅内动脉粥样硬化的介入治疗数据，以此作为质量评价的基准。我们设法确定那些可能影响操作成功和并发症风险的危险因素。本文针对颅内动脉粥样硬化狭窄或闭塞的血管内治疗临床试验设计的重要因素，提出了各种临床和技术方面的基本原则。本指南还包含了对这类临床试验统一报道标准的建议。这些定义和标准主要用于研究目的；不过，它们对于临床实践也应有所帮助，并且适用于所有出版物。结论总之，这些建议的定义代表了为构建有效研究数据集的推荐意见。其目的是促进科学而严谨的研究结果的产生，使类似研究之间和内部进行可靠的比较成为可能。在某些情况下，本指南中的一些定义由写作组的专家团队一致推荐，以使报道和发表一致。这些定义应能让不同研究小组发表能够进行直接比较的研究结果。

Transcatheter arterial chemoembolization in recurrent unresectable hepatocellular carcinoma after orthotopic liver transplantation

Aim: To investigate the survivals and efficacy of the doxorubicin drug eluting beads transcatheter arterial chemoembolization (TACE) in patients with recurrent hepatocellular carcinoma (HCC) status post orthotopic liver transplantation. Methods: Consecutive patients with HCC who underwent orthotopic liver transplantation from 2005 to 2012 were reviewed. Patients who developed recurrent HCC after orthotopic liver transplantation and received doxorubicin drug eluting beads TACE therapy were identified and included in the study. Survivals were calculated from the time of 1st doxorubicin drug eluting beads TACE of recurrent HCC. Kaplan Meier estimator with log rank test was used for survival analysis. Results: Eight patients had recurrent HCC after orthotopic liver transplantation and received doxorubicin drug eluting beads TACE. The overall median survival of these patients was 15.6 months. Two patients had significantly poorer overall median survival from doxorubicin drug eluting beads TACE (3.4 months) and both showed elevated serum alpha-fetoprotein levels (> 400 ng/mL) and extra-hepatic metastases (P = 0.03). Patients with poorly differentiated HCC in explant liver had the poor median overall survival (3.6 months) compared to the patients with well-to-moderately differentiated HCC (21.7 months, P = 0.004). Conclusion:Doxorubicin drug eluting beads TACE appears to be an effective treatment option for patients with recurrent HCC after orthotopic liver transplantation.

Practical considerations in starting a peripheral lymphedema magnetic resonance imaging program

The management of chronic peripheral lymphedema benefits from a multidisciplinary approach in which magnetic resonance imaging(MRI)can play a key role.The imaging has been well described in the literature(including this journal),but the process for starting a novel imaging service line is complex.Participants in this process,including radiologists,imaging technical staff,information technologists,and revenue cycle managers,must be engaged and work in harmony to achieve success.The purpose of this article is to detail the building blocks and steps in starting a peripheral lymphedema MRI program,how our process evolved,and lessons learned along the way.