Bacille Calmette-Guérin Vaccine-Induced Tuberculous Elbow Osteomyelitis in an Infant: A Case Report.

CASE: We report a case of Bacillus Calmette-Guérin (BCG) vaccine-induced osteomyelitis of the distal end of the right humerus in a 1-year and 8-month-old girl. The patient was treated with debridement and a 12-month antituberculosis drug. After 3 years of follow-up, no growth disturbances or sequelae were observed. CONCLUSION: BCG osteomyelitis is difficult to diagnose because of its rarity. It is important to suspect BCG osteomyelitis based on symptoms and blood tests and to perform PCR testing. Long-term follow-up after treatment is necessary to monitor for recurrence and avoid growth disturbances until epiphyseal line closure occurs.

Deep learning-based reconstruction can improve the image quality of low radiation dose head CT.

OBJECTIVES: To evaluate the image quality of deep learning-based reconstruction (DLR), model-based (MBIR), and hybrid iterative reconstruction (HIR) algorithms for lower-dose (LD) unenhanced head CT and compare it with those of standard-dose (STD) HIR images. METHODS: This retrospective study included 114 patients who underwent unenhanced head CT using the STD (n = 57) or LD (n = 57) protocol on a 320-row CT. STD images were reconstructed with HIR; LD images were reconstructed with HIR (LD-HIR), MBIR (LD-MBIR), and DLR (LD-DLR). The image noise, gray and white matter (GM-WM) contrast, and contrast-to-noise ratio (CNR) at the basal ganglia and posterior fossa levels were quantified. The noise magnitude, noise texture, GM-WM contrast, image sharpness, streak artifact, and subjective acceptability were independently scored by three radiologists (1 = worst, 5 = best). The lesion conspicuity of LD-HIR, LD-MBIR, and LD-DLR was ranked through side-by-side assessments (1 = worst, 3 = best). Reconstruction times of three algorithms were measured. RESULTS: The effective dose of LD was 25% lower than that of STD. Lower image noise, higher GM-WM contrast, and higher CNR were observed in LD-DLR and LD-MBIR than those in STD (all, p ≤ 0.035). Compared with STD, the noise texture, image sharpness, and subjective acceptability were inferior for LD-MBIR and superior for LD-DLR (all, p < 0.001). The lesion conspicuity of LD-DLR (2.9 ± 0.2) was higher than that of HIR (1.2 ± 0.3) and MBIR (1.8 ± 0.4) (all, p < 0.001). Reconstruction times of HIR, MBIR, and DLR were 11 ± 1, 319 ± 17, and 24 ± 1 s, respectively. CONCLUSION: DLR can enhance the image quality of head CT while preserving low radiation dose level and short reconstruction time. KEY POINTS: • For unenhanced head CT, DLR reduced the image noise and improved the GM-WM contrast and lesion delineation without sacrificing the natural noise texture and image sharpness relative to HIR. • The subjective and objective image quality of DLR was better than that of HIR even at 25% reduced dose without considerably increasing the image reconstruction times (24 s vs. 11 s). • Despite the strong noise reduction and improved GM-WM contrast performance, MBIR degraded the noise texture, sharpness, and subjective acceptance with prolonged reconstruction times relative to HIR, potentially hampering its feasibility.

Radiation dose optimization potential of deep learning-based reconstruction for multiphase hepatic CT: A clinical and phantom study.

PURPOSE: This clinical and phantom study aimed to evaluate the impact of deep learning-based reconstruction (DLR) on image quality and its radiation dose optimization capability for multiphase hepatic CT relative to hybrid iterative reconstruction (HIR). METHODS: Task-based image quality was assessed with a physical evaluation phantom; the high- and low-contrast detectability of HIR and DLR images were computed from the noise power spectrum and task-based transfer function at five different size-specific dose estimate (SSDE) values in the range 5.3 to 18.0-mGy. For the clinical study, images of 73 patients who had undergone multiphase hepatic CT under both standard-dose (STD) and lower-dose (LD) examination protocols within a time interval of about four-months on average, were retrospectively examined. STD images were reconstructed with HIR, while LD with HIR (LD-HIR) and DLR (LD-DLR). SSDE, quantitative image noise, and contrast-to-noise ratio (CNR) were compared between protocols. The noise magnitude, noise texture, streak artifact, image sharpness, interface smoothness, and overall image quality were subjectively rated by two independent radiologists. RESULTS: In phantom study, the high- and low-contrast detectability of DLR images obtained at 5.3-mGy and 7.3-mGy, respectively, were slightly higher than those obtained with HIR at the STD protocol dose (18.0-mGy). In clinical study, LD-DLR yielded lower image noise, higher CNR, and higher subjective scores for all evaluation criteria than STD (all, p ≤ 0.05), despite having 52.8% lower SSDE (8.0 ± 2.5 vs. 16.8 ± 3.4-mGy). CONCLUSIONS: DLR improved the subjective and objective image quality of multiphase hepatic CT compared with HIR techniques, even at approximately half the radiation dose.

Bone marrow transplantation from a human leukocyte antigen-mismatched unrelated donor in a case with C1q deficiency associated with refractory systemic lupus erythematosus.

Human C1q deficiency is frequently associated with systemic lupus erythematosus (SLE), which requires long-term systemic corticosteroid administration. We report the case of a 12-year-old female patient with C1q deficiency presenting with intractable SLE who successfully underwent bone marrow transplantation from a human leukocyte antigen (HLA)-mismatched unrelated donor with an immunosuppressive conditioning regimen based on fludarabine, melphalan, and anti-thymocyte globulin. She developed Grade I graft-versus-host disease, but did not have any transplantation-related morbidity. Complete donor chimerism has been maintained for 2 years after transplantation, leading to the restoration of C1q levels and the resolution of SLE symptoms. Normal C1q mRNA expression was observed in CD14 + cells. Hematopoietic stem cell transplantation from an HLA-mismatched donor is a feasible treatment for patients with C1q deficiency with refractory SLE that is dependent on systemic corticosteroid treatment who do not have an HLA-matched donor.

Hybrid of Compressed Sensing and Parallel Imaging Applied to Three-dimensional Isotropic T2-weighted Turbo Spin-echo MR Imaging of the Lumbar Spine.

PURPOSE: The hybrid compressed sensing (hybrid-CS) technique can shorten the acquisition time compared with the sensitivity encoding (SENSE) technique in lumbar MRI. To evaluate the feasibility of a hybrid-CS technique in comparison with 3D isotropic T2-weighted turbo spin-echo (3D volume isotropic turbo spin-echo acquisition [VISTA]) MRI of the lumbar spine. MATERIALS AND METHODS: The Institutional Review Board approved this study and informed consent was obtained from participants prior to study entry. Sixteen healthy volunteers underwent lumbar spine 3D VISTA with conventional parallel imaging for SENSE and hybrid-CS at 3T. We recorded the image acquisition times of SENSE and hybrid-CS. We compared the signal-to-noise ratio (SNR) in spine, cerebrospinal fluid (CSF), lumbar disc, epidural fat, and erector spinae muscle, and the contrast of spine, CSF, and disc, and performed qualitative image analysis assessment, between the two image sequences. RESULTS: The image acquisition time for hybrid-CS was 39.2% shorter than that of SENSE (218.4/358.8 s). The contrast of CSF and SNR of the spine was significantly higher with hybrid-CS than with SENSE (P < 0.05). The SNR of the disc and muscle was significantly higher with SENSE than with hybrid-CS (P < 0.05). There were no significant differences in the contrast of spine, disc, and fat, and SNR of CSF and fat between hybrid-CS and SENSE. There were no significant differences in the qualitative evaluation between hybrid-CS and SENSE. CONCLUSION: Compared with SENSE, hybrid-CS for 3D VISTA can shorten image acquisition time without sacrificing image quality.

Transcription factor homeobox D9 is involved in the malignant phenotype of cervical cancer through direct binding to the human papillomavirus oncogene promoter.

OBJECTIVE: To determine the involvement of homeobox D9 (HOXD9) in the survival, proliferation, and metastasis of cervical cancer cells through regulating the expression of human papillomavirus (HPV) 16 E6/E7 genes using the P97 promoter. METHODS: One hundred cases of cervical cancer (CC), CC cell lines SKG-I, SKG-II, SKG-IIIa, SKG-IIIb, HeLa, and SiHa, and a human tumor xenograft mouse model were used to examine the roles of HOXD9 in CC. Knockdown experiments employed RNA interference of HOXD9. qPCR, functional assays, western blotting, DNA microarray, and luciferase and ChIP assays were applied for assessments. RESULTS: All CC cell lines expressed HOXD9 mRNA and protein. In uterine CC, HOXD9 gene expression was significantly higher than in normal cervical tissues. A positive correlation of lymphovascular space invasion and lymph node metastasis with high levels of HOXD9 expression was found in patient samples. HOXD9-knockdown cells in the mouse xenograft model only formed small or no tumors. Knockdown of HOXD9 markedly reduced CC cell proliferation, migration and invasion, induced apoptosis, increased P53 protein expression, and suppressed HPV E6/E7 expression by directly binding to the P97 promoter of HPV16 E6/E7 genes. A positive correlation between HOXD9 and HPV16 E6 expression was found in CC patients. CONCLUSIONS: HOXD9 promotes HPV16 E6 and E7 expression by direct binding to the P97 promoter, which enhances proliferation, migration, and metastasis of CCr cells. Our results suggest that HOXD9 could be a prognostic biomarker and potential therapeutic target in CC.

Effect of essential amino acids on enteroids: Methionine deprivation suppresses proliferation and affects differentiation in enteroid stem cells.

We investigated the effects of essential amino acids on intestinal stem cell proliferation and differentiation using murine small intestinal organoids (enteroids) from the jejunum. By selectively removing individual essential amino acids from culture medium, we found that 24 h of methionine (Met) deprivation markedly suppressed cell proliferation in enteroids. This effect was rescued when enteroids cultured in Met deprivation media for 12 h were transferred to complete medium, suggesting that Met plays an important role in enteroid cell proliferation. In addition, mRNA levels of the stem cell marker leucine-rich repeat-containing G protein-coupled receptor 5 (Lgr5) decreased in enteroids grown in Met deprivation conditions. Consistent with this observation, Met deprivation also attenuated Lgr5-EGFP fluorescence intensity in enteroids. In contrast, Met deprivation enhanced mRNA levels of the enteroendocrine cell marker chromogranin A (ChgA) and markers of K cells, enterochromaffin cells, goblet cells, and Paneth cells. Immunofluorescence experiments demonstrated that Met deprivation led to an increase in the number of ChgA-positive cells. These results suggest that Met deprivation suppresses stem cell proliferation, thereby promoting differentiation. In conclusion, Met is an important nutrient in the maintenance of intestinal stem cells and Met deprivation potentially affects cell differentiation.

Decreased gene expressions of insulin signal molecules in canine hyperadrenocorticism.

Hyperadrenocorticism (HAC) is a common endocrine disorder in dogs, in which excess glucocorticoid causes insulin resistance. Disturbance of insulin action may be caused by multiple factors, including transcriptional modulation of insulin signal molecules which lie downstream of insulin binding to insulin receptors. In this study, gene expressions of insulin signal molecules were examined using neutrophils of the HAC dogs (the untreated dogs and the dogs which had been treated with trilostane). Insulin receptor substrate (IRS)-1, IRS-2, phosphatidylinositol 3-kinase (PI3-K), protein kinase B/Akt kinase (Akt)-2 and protein kinase C (PKC)-lambda were analyzed in the HAC dogs and compared with those from normal dogs. The IRS-1 gene expressions decreased by 37% and 35% of the control dogs in the untreated and treated groups, respectively. The IRS-2 gene expressions decreased by 61% and 72%, the PI3-K gene expressions decreased by 47% and 55%, and the Akt-2 gene expressions decreased by 45% and 56% of the control dogs, similarly. Collectively, gene expressions of insulin signal molecules are suppressed in the HAC dogs, which may partially contribute to the induction of insulin resistance.

Usefulness of the SPACE pulse sequence at 1.5T MR cholangiography: comparison of image quality and image acquisition time with conventional 3D-TSE sequence.

PURPOSE: To prospectively evaluate the image quality and image acquisition time at 3D magnetic resonance cholangiopancreatography (MRCP) using sampling perfection with application optimized contrasts (SPACE) and conventional turbo-spin-echo (TSE) sequences. MATERIALS AND METHODS: We acquired navigator-triggered SPACE and conventional 3D-TSE MRCP images using the same parameters where possible for 30 patients and compared the image acquisition time, contrast, and contrast-to-noise ratio (CNR) of the common bile duct (CBD). Two radiologists performed qualitative analyses using a 4-point scale. RESULTS: Image acquisition time was 31% shorter with the SPACE than the conventional TSE sequence (248.9 ± 73.0 sec vs. 360.5 ± 99.9 sec, P < 0.01). The contrast and CNR was significantly higher with the SPACE technique than conventional TSE (39.4 ± 14.7 vs. 33.5 ± 14.2, P < 0.01 and 18.6 ± 7.8 vs. 15.5 ± 9.3, P = 0.03). All visual scores were higher for the SPACE than the conventional TSE sequence; there was a significant difference in motion artifacts and the depiction of the CBD and the left hepatic and main pancreatic duct (P < 0.05). CONCLUSION: On the 1.5T MR scanner, 3D-MRCP with the SPACE sequence significantly improved the contrast and CNR of CBD. In addition, it yielded images of better quality at 30% shorter acquisition time than constant refocusing pulse flip angle TSE.

Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality.

PURPOSE: To evaluate the effect on image quality of a low contrast agent dose and radiation dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage, hybrid iterative reconstruction algorithm, and a 256- detector row scanner. MATERIALS AND METHODS: This prospective study received institutional review board approval, and prior informed written consent was obtained from all patients. Seventy-four patients undergoing hepatic dynamic CT were randomly assigned to one of two protocols: Thirty-nine patients underwent scanning with the conventional 120-kVp protocol and the other 35 patients underwent scanning with an 80-kVp tube voltage and a 40% reduction in contrast agent dose. The 80-kVp images were also postprocessed with a hybrid iterative reconstruction algorithm. The estimated effective radiation dose of each protocol was compared and the image noise and contrast-to-noise-ratio (CNR) of the 120-kVp, 80-kVp, and hybrid iterative reconstructed 80-kVp images were evaluated by using the Student t test. RESULTS: The effective radiation dose was 51% lower during the hepatic arterial phase (HAP) and 48% lower during the portal venous phase (PVP) with the 80-kVp protocol than with the 120-kVp protocol (HAP: 5.6 mSv ± 1.0 [standard deviation] vs 11.6 mSv ± 3.3; PVP: 5.8 mSv ± 0.7 vs 11.2 mSv ± 3.2, respectively). The hybrid iterative reconstruction decreased image noise by 23% during the HAP (9.2 ± 1.9 vs 12.0 ± 2.6) and by 24% during the PVP (9.4 ± 1.8 vs 12.3 ± 2.6). There were no significant differences in the CNR of any of the regions of interest between 80-kVp with iterative reconstruction and 120-kVp protocols (P = .46-.85). CONCLUSION: A low tube voltage and the hybrid iterative reconstruction algorithm can dramatically decrease radiation and contrast agent doses with adequate image quality at hepatic dynamic CT of thin adults with use of a 256-detector row scanner.

Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT.

PURPOSE: To evaluate the feasibility of a low-contrast agent dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage high tube current-time product technique and a 256-detector row CT unit. MATERIALS AND METHODS: This prospective study received institutional review board approval; written informed consent to participate was obtained from all patients. The study included 151 patients; 117 had an estimated glomerular filtration rate (eGFR) greater than or equal to 60 mL/min/1.73 m(2). These patients were examined with the conventional 120-kVp protocol. The other 34 patients underwent scanning with an 80-kVp tube voltage, a high tube current-time product, and a 40% reduction in contrast agent dose. Effective dose (ED), image noise, attenuation, contrast-to-noise ratio (CNR), and figure of merit of the aorta in the arterial phase and of the portal vein and hepatic parenchyma in the portal venous phase in the two groups were compared with the Student t test. RESULTS: Estimated ED was about 20% lower with the 80-kVp protocol than with the 120-kVp protocol. There were no significant differences in CNR in any region of interest between the 80-kVp protocol and the 120-kVp protocol (abdominal aorta: 36.9 ± 9.7 [standard deviation] vs 36.1 ± 8.1, P = .63; portal vein: 13.4 ± 3.2 vs 13.1 ± 3.2, P = .65; hepatic parenchyma: 6.4 ± 2.6 vs 6.7 ± 2.3, P = .51). CONCLUSION: Contrast dose at hepatic dynamic 256-detector row CT in patients with renal dysfunction can be decreased by 40% with this protocol by using the 80-kVp setting and a high tube current-time product.

Asymptomatic cystic changes in the brain of children after cranial irradiation: frequency, latency, and relationship to age.

INTRODUCTION: Although radiation therapy plays an important role in the management of children with brain tumors, radiation-induced brain damage sometimes occurs after radiation therapy. In some pediatric patients who had undergone cranial radiation therapy, we noticed cystic changes in the brain on follow-up MRI. The purpose of this study was to determine the frequency, latency, relationship with patient age, radiation dose, and serial change in the cystic changes in children after cranial irradiation. METHODS: We retrospectively studied MRI in 33 children who had undergone cranial irradiation for their primary brain tumors. Postirradiation cystic change in the brain on follow-up MRI was defined as a well-demarcated, oval-shaped, CSF-like signal intensity area, and no contrast enhancement. RESULTS: Of the 33 patients, 6 (18.2%) had one or more cystic lesions. The latency of the cystic changes ranged from 1.5 to 7 years (mean 2.6 years). Cystic changes were found in the subcortical, periventricular and other deep white matter and the basal ganglia. The size of the lesions ranged from 1 to 10 mm at their first appearance; eight cystic lesions increased in size. None the cystic lesions reduced in size or resolved with time and none required intervention. All patients with cystic changes had received irradiation when they were 6 years of age or younger. The cystic changes occurred within the radiation field in patients treated with a radiation dose of 36 Gy or more. CONCLUSION: Asymptomatic brain parenchymal cystic changes appear to occur in children who have undergone cranial irradiation at 6 years of age or younger.