Apparent diffusion coefficient values in differential diagnosis and prognostic prediction of solitary of fibrous tumor/hemangiopericytoma (WHOII) and atypical meningioma.

BACKGROUND: It is difficult to distinguish solitary of fibrous tumor/hemangiopericytoma (SFT/HPC) from atypical meningioma (AM) by conventional imaging.As far as we know,diffusion weighting imaging may identify them effectively. OBJECTIVE: The purpose of this study was to determine the role of apparent diffusion coefficient (ADC) values to distinguish and predict prognosis of solitary of fibrous tumor/hemangiopericytoma (SFT/HPC) (WHOII) and atypical meningioma (AM). METHODS: Preoperative diffusion-weighted imaging (DWI) of 30 cases with histopathologic and immunhistochemical testified SFT/HPC WHOII (n= 11) and AM (n= 19) were performed retrospectively. The ADC values of lesion, peritumoral edema, normal white matter and lesion NADC ratio (lesion ADC values/ADC values of normal white matter (NWN ADC)) were compared. The immunhistochemical markers (Ki-67, CD34, Vim, EMA, GFAP, S-100, PR, CD56) were compared. The correlation between the ADC values and Ki-67 index was evaluated. RESULTS: The mean lesion ADC values of SFT/HPC (1.15 ± 0.04 × 10-3 mm2/s) was significantly higher than that of AM (0.80 ± 0.04 × 10-3 mm2/s) (t= 23.824, p< 0.05). The mean NADC ratio was lower for AM (1.03 ± 0.06) compared with SFT/HPC (1.51 ± 0.05) (t= 23.105, p< 0.05). The mean edema ADC for SFT/HPC (1.47 ± 0.06 × 10-3 mm2/s) was lower compared with AM (1.68 ± 0.05 × 10-3 mm2/s) (t=-9.926, p< 0.05 ). There was no statistical difference between the two groups of NWM ADC (t=-1.475, p> 0.05) . The mean Ki-67 of SFT/HPC (7.18 ± 2.60%) was lower than the mean Ki-67 of AM (13.58 ± 4.50%) (t=-4.934, p< 0.05). The CD34 showed statistically differences between two groups (X2= 13.659, p< 0.05). The EMA also showed statistically differences between two groups (X2= 4.474, p< 0.05). Vim,GFAP, S-100, PR, CD56 showed no statistical difference in the two group (p> 0.05). The pearson analysis indicated that there was a negative correlation between lesion ADC and Ki-67 in SFT/HPC group (r=-0.770, p< 0.05) and AM group (r=-0.727, p< 0.05). There was also a negative correlation between lesion NADC ratio and Ki-67 in SFT/HPC group (r=-0.673, p< 0.05) and AM group (r=-0.707, p< 0.05). There was a positive correlation between edema ADC and Ki-67 in SFT/HPC group (r= 0.819, p< 0.05) and AM group (r= 0.942, p< 0.05). Furthermore,there was no correlation between NWM A DC and Ki-67 in SFT/HPC group (r=-0.403, p> 0.05) and AM group (r= 0.202, p> 0.05). CONCLUSIONS: The lesion ADC, lesion NADC ratio and edema ADC can distinguish the SFT/HPC WHO II from AM and be helpful to predict prognosis of the two tumors before operation. Further more, histopathologic and immunhistochemical can make a definite diagnosis of the two tumors.

Diagnostic Performance of Apparent Diffusion Coefficient for Prediction of Grading of Pancreatic Neuroendocrine Tumors: A Systematic Review and Meta-analysis.

OBJECTIVES: The aim of this study was to evaluate the diagnostic value of apparent diffusion coefficient (ADC) for the World Health Organization grade of pancreatic neuroendocrine tumors (pNETs). METHODS: The MEDLINE, Google Scholar, PubMed, and Embase databases were searched to identify relevant original articles investigating the ADC value in predicting the grade of pNETs. The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated by using random effects models. Subgroup analysis was performed to discover heterogeneity effects. RESULTS: Nine studies with 386 patients met our inclusion criteria. For identifying G1 from G2/3, the pooled SE, SP, PLR, NLR, and area under the curve of the summary receiver operating characteristic curve were 0.84 (95% confidence interval [95% CI], 0.73-0.91), 0.87 (95% CI, 0.72-0.94), 6.3 (95% CI, 2.7-14.6), 0.19 (95% CI, 0.10-0.34), and 0.91 (95% CI, 0.89-0.94), respectively. The summary estimates for ADC in distinguishing G3 from G1/2 were as follows: SE, 0.93 (95% CI, 0.66-0.99); SP, 0.92 (95% CI, 0.86-0.95); PLR, 11.1 (95% CI, 6.6-18.6); NLR, 0.08 (95% CI, 0.01-0.45); and area under the curve, 0.92 (95% CI, 0.85-0.96). CONCLUSIONS: Diffusion-weighted imaging is a reliable tool for predicting the grade of pNETs, especially for G3. Moreover, the combination of 3.0-T device and higher b value can slightly help improve SE and SP.

Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis.

The aim of this study was to assess the diagnostic performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/MRI for suspected recurrence of pelvis malignancies of female patients using a meta-analysis. We performed a systematical literature search for relevant studies in PubMed, Cochrane Library, Google Scholar, and several Chinese databases. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of all included studies. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated per patient and per lesion. Summary receiver operating characteristic curves were also constructed. All procedures involving human participants in this study were performed in conformity with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Finally, seven articles comprising 257 patients and 695 lesions were included in this meta-analysis. On patient-based analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG PET/MRI in detecting recurrence of pelvis malignancies were 0.96 [95% confidence interval (CI): 0.93-0.99], 0.95 (95% CI: 0.87-0.99), 9.85 (95% CI: 4.62-21.00), 0.07 (95% CI: 0.04-0.13), and 201.41 (95% CI: 62.89-645.03), respectively. On lesion-based analysis, the corresponding estimates were 0.99 (95% CI: 0.97-1.00), 0.94 (95% CI: 0.89-0.97), 17.11 (95% CI: 4.46-65.60), 0.02 (95% CI: 0.01-0.05), and 1125.24 (95% CI: 211.46-5987.79), respectively. The results of our meta-analysis indicate that F-FDG PET/MRI has excellent diagnostic performance in restaging female patients with suspected recurrence of gynecological pelvic malignancies.

Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification.

BACKGROUND: A nonrecurrent laryngeal nerve (NRLN) is a rare but potentially serious anatomical variant. Although the incidence is reported to be 0.3% to 1.3%, it carries a much higher risk of palsy during thyroid surgery. The objective of this study is to investigate the usefulness of computed tomography (CT) for preoperative identification and intraoperative neuromonitoring identification (IONM) of NRLN in thyroid cancer patients. METHODS: The preoperative neck CT scans from 1,574 patients who needed thyroid surgery were examined. Absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria were defined as positive with NRLN. Systematic intraoperative neuromonitoring (IONM) was also carried out for these 1,574 patients to localize and identify NRLN. A negative electromyography (EMG) response from lower vagal stimulation but a positive EMG response from the upper position indicated the occurrence of an NRLN. RESULTS: Nine NRLN (0.57%) were intraoperatively identified out of the 1,574 patients, and no patient with a NRLN showed preoperative clinical symptoms related to NRLN. Prior to the operation, surgeons identified only seven suspected NRLN cases based on identification of arteria lusoria. But a review of CT scans revealed that all cases could be identified by vascular anomalies. All patients were successfully detected at an early stage of operation using intraoperative neuromonitoring (IONM). Postoperative vocal cord function was normal in all patients. CONCLUSIONS: CT of the neck is a reliable method for predicting NRLN before thyroid cancer surgery. However, some image features can be easily missed. Neurophysiology helps the surgeon to identify the NRLNs more precisely. Combining the two evaluation methods may decrease the incidence of nerve palsy, especially in cases of NRLN. Considering that CT is expensive, requires an X-ray, and achieves less information than ultrasound (US) concerning thyroid nodules, we suggest that applying US and IONM is more reasonable.

Anode-biofilm electron transfer behavior and wastewater treatment under different operational modes of bioelectrochemical system.

Anode-biofilm electron transfer behavior was investigated during the advanced wastewater treatment process by three bioelectrochemical systems (BESs): microbial fuel cell (MFC), MFC operated under short circuit condition (MSC), and microbial electrolysis cell (MEC). Under different operational modes, current produced by the anode biofilm varied from 0.92, 4.15 to 8.21mA in the sequence of MFC, MSC and MEC, respectively. The cyclic voltammetry test on the anode biofilm suggested that the current generation was achieved via various bioelectroactive species with formal potentials at -0.473, -0.402 and -0.345V (vs. SCE). Gibbs free energy and charge transfer resistance data demonstrated that different amounts of available bioelectroactive species functioned in different BESs. The comparative investigation among MFC, MSC and MEC suggested that MEC was the only feasible operational mode for advanced wastewater treatment, because of its superior current generation capability.

Ultrasound guidance for the creation of a small animal model of aortic injury.

PURPOSE: To develop a small animal model of controlled aortic intimal injury with ultrasound (US) imaging guidance. MATERIALS AND METHODS: Via carotid artery cutdown, a custom-made microcatheter/angled metal device system was advanced to damage the intima of the ascending aortas of 20 Sprague-Dawley rats and 10 JCR atherosclerotic rats. This minimally invasive endovascular procedure was monitored by a clinical US imaging system. Injured aortas were harvested for histologic confirmation via a grading system: grade I, intima injury; grade II, injury to media; and grade III, injury through the entire aortic wall. Neointimal reactions at the injury site were compared by calculating the ratio of intimal to medial thickness among different animal groups at various survival times (week 1, weeks 2-3, and weeks 4-7). RESULTS: Clear visualization of the architecture of the heart and great vessels and the exact location of the angled metal device by US imaging ensured consistent intimal damage of the aorta. Histopathologic analysis confirmed that most of the aortic injures were classified as grade I. There was no significant difference between the two rat groups. Analysis of pathophysiologic reactions at the injury sites revealed increased thickening of neointimal hyperplasia as animal survival times extended from week 1 to weeks 4-7 after the aortic interventions. CONCLUSIONS: This study demonstrates the feasibility of clinical US imaging to precisely guide the creation of controlled aortic intimal injury in rats, which may become a useful tool to facilitate research involving the prevention and treatment of atherosclerotic cardiovascular disease.

Magnetosonoporation: instant magnetic labeling of stem cells.

The purpose of this study was to develop an instant MR cell labeling technique, called magnetosonoporation. First, a magnetosonoporation apparatus was successfully established for MR labeling of stem cells. Then, the safety of this new cell labeling approach was confirmed by evaluation of cell viability, proliferation, and differentiation of magnetosonoporation-labeled and unlabeled C17.2 neural stem cells. Subsequently, the feasibility of using in vivo MRI to detect magnetosonoporation/Feridex-labeled stem cells was validated in living animals and confirmed by histologic correlation. The magnetosonoporation technique is expected to be convenient, efficient, and safe for future clinical application of MRI-guided cell therapies.

Dual transfer of GFP gene and MGd into stem-progenitor cells: toward in vivo MRI of stem cell-mediated gene therapy of atherosclerosis.

RATIONALE AND OBJECTIVES: The aim of this study was to develop a new technique, the use of magnetic resonance (MR) imaging (MRI) to monitor gene/MR-cotransferred stem-progenitor cells (SPCs) recruited to atherosclerosis. MATERIALS AND METHODS: First, a green fluorescent protein (GFP) gene and a T1 MR contrast agent (motexafin gadolinium [MGd]) were cotransferred into neural or bone marrow (BM)-derived SPCs. GFP expression and MGd signal were confirmed by fluorescent microscopy and quantified by flow cytometry. Cell viability and proliferation were then evaluated by trypan blue exclusion and 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium assay, and GFP/MGd-transferred cells were imaged using 1.5-T and 9.4-T MR scanners. For in vivo validation, GFP/MGd-cotransferred beta-galactosidase-BM SPCs were transplanted to apolipoprotein E-knockout mice, and cell migration to atherosclerotic aortas was monitored using 9.4-T micro-MRI with subsequent histologic correlations. RESULTS: Fluorescent microscopy demonstrated simultaneous GFP expression and MGd signals in cotransferred-cells. Quantitative flow cytometry showed GFP-positive cells at 47 +/- 25% and 56 +/- 12% and MGd-positive cells at 96 +/- 6% and 57 +/- 11% for neural stem cells and BM cells, respectively. Cell viability and metabolic rates of cotransferred cells were 86 +/- 4% and 84 +/- 12%, respectively. In vivo MRI revealed high MR signals of the aortic walls in GFP/MGd-transferred mice, which were confirmed by histologic correlations. CONCLUSION: This study has initially proven the new concept of MRI for plaque-specific, cell-mediated gene expression of atherosclerosis.

Optimization of magnetosonoporation for stem cell labeling.

Recent advances in magnetic cell labeling have taken place with the development of a magnetosonoporation (MSP) technique. The aim of this study was to optimize the MSP protocol in order to achieve high cell viability and intracellular uptake of MR contrast agents. First, we determined the sub-optimal MSP parameters by evaluating the viabilities of C17.2 neural stem cells without Feridex using various MSP intensities ranging from 0.1 to 1 w/cm(2), duty cycles at 20%, 50% or 100%, and exposure times from 1-15 min. The sub-optimized MSP parameters with cell viabilities greater than 90% were further optimized by evaluating both cell viability and intracellular iron uptake when Feridex was used. We then used the optimized MSP parameters to determinate the optimal concentration of Feridex for magnetic cell labeling. Subsequently, we validated the feasibility of using MRI to track the migration of neural stem cells from the transplanted sites to glioma masses in four mouse brains when the cells had been labeled with Feridex using the optimized MSP protocol. The MRI findings were confirmed by histological correlations. In vitro experiments demonstrated that the optimal MSP protocol was achieved at 20% duty cycle, 0.3 w/cm(2) ultrasound intensity, 5-min exposure time and 1 mg/mL Feridex. This study demonstrated that the optimized MSP cell labeling technique can achieve both high cell viability and intracellular uptake of MR contrast agents, and has the potential to be a useful cell labeling technique to facilitate future clinical translation of MRI-integrated cell therapy.

[Pathologic and X-ray features of primary malignant fibrous histiocytoma of bone--a report of 16 cases].

BACKGROUND & OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a common soft tissue tumor, which rarely occur in the skeleton. Its histological origin still remains controversial. This study was to investigate the pathologic and X-ray features of primary MFH of bone, and provide reference for imaging diagnosis. METHODS: Clinical data and X-ray images of 16 MFH patients, treated from Jan. 1982 to Jun. 2002 in the First Affiliated Hospital of Soochow University, were analyzed retrospectively. RESULTS: Pathologic manifestations of the patients were malignant multinucleated giant cells, pleomorphic and bizarre form of the tumor cells, and wheel-spoke arrangement of the fibroblast-like cells. Pathologically, the tumor tissue was consisted of various kinds of cells, which were mainly fibroblasts and histiocytes. The principal X-ray manifestations included solitary osteolytic changes, cortical expansion around the tumor, the penetration of the cortex with soft tissue mass formation, slight periosteal reaction and pathologic fracture. CONCLUSION: The diagnosis of MFH mainly depends on pathologic examination and X-ray manifestations.