Vascular study of decellularized porcine long bones: Characterization of a tissue engineering model.

INTRODUCTION: Massive bone allografts enable the reconstruction of critical bone defects in numerous conditions (e.g. tumoral, infection or trauma). Unfortunately, their biological integration remains insufficient and the reconstruction may suffer from several postoperative complications. Perfusion-decellularization emerges as a tissue engineering potential solution to enhance osseointegration. Therefore, an intrinsic vascular study of this novel tissue engineering tool becomes essential to understand its efficacy and applicability. MATERIAL AND METHODS: 32 porcine long bones (humeri and femurs) were used to assess the quality of their vascular network prior and after undergoing a perfusion-decellularization protocol. 12 paired bones were used to assess the vascular matrix prior (N = 6) and after our protocol (N = 6) by immunohistochemistry. Collagen IV, Von Willebrand factor and CD31 were targeted then quantified. The medullary macroscopic vascular network was evaluated with 12 bones: 6 were decellularized and the other 6 were, as control, not treated. All 12 underwent a contrast-agent injection through the nutrient artery prior an angio CT-scan acquisition. The images were processed and the length of medullary vessels filled with contrast agent were measured on angiographic cT images obtained in control and decellularized bones by 4 independent observers to evaluate the vascular network preservation. The microscopic cortical vascular network was evaluated on 8 bones: 4 control and 4 decellularized. After injection of gelatinous fluorochrome mixture (calcein green), non-decalcified fluoroscopic microscopy was performed in order to assess the perfusion quality of cortical vascular lacunae. RESULTS: The continuity of the microscopic vascular network was assessed with Collagen IV immunohistochemistry (p-value = 0.805) while the decellularization quality was observed through CD31 and Von Willebrand factor immunohistochemistry (p-values <0.001). The macroscopic vascular network was severely impaired after perfusion-decellularization; nutrient arteries were still patent but the amount of medullary vascular channels measured was significantly higher in the control group compared to the decellularized group (p-value <0.001). On average, the observers show good agreement on these results, except in the decellularized group where more inter-observer discrepancies were observed. The microscopic vascular network was observed with green fluoroscopic signal in almost every canals and lacunae of the bone cortices, in three different bone locations (proximal metaphysis, diaphysis and distal metaphysis). CONCLUSION: Despite the aggressiveness of the decellularization protocol on medullary vessels, total porcine long bones decellularized by perfusion retain an acellular cortical microvascular network. By injection through the intact nutrient arteries, this latter vascular network can still be used as a total bone infusion access for bone tissue engineering in order to enhance massive bone allografts prior implantation.

Diffuse vertebral marrow changes at MRI: Multiple myeloma or normal?

Five MRI patterns of marrow involvement (diffuse, focal, combined diffuse and focal, variegated, and normal) are observed in patients with a marrow proliferative disorder including MM. The wide range of marrow involvement patterns in monoclonal plasma cell proliferative disorders mirrors that of their natural histories that can vary from indolent to rapidly lethal. MRI of the axial bone marrow contributes to stage these disorders, but it should not be obtained for disease detection and characterization because of its limited specificity and sensitivity. At MRI, diffuse benign hematopoietic marrow hyperplasia and marrow heterogeneities in elderly patients mimic the diffuse and variegated patterns observed in MM patients. Careful analysis of fat- and fluid-sensitive MR images and quantitative marrow assessment by using MRI and FDG-PET can contribute in differentiating these changes from those associated with neoplastic marrow infiltration, with some residual overlapping findings.

Fat suppression at three-dimensional T1-weighted MR imaging of the hands: Dixon method versus CHESS technique.

PURPOSE: To compare the effectiveness of fat suppression and the image quality of the Dixon method with those of the chemical shift-selective (CHESS) technique in hands of normal subjects at non-enhanced three-dimensional (3D) T1-weighted MR imaging. MATERIALS AND METHODS: Both hands of 14 healthy volunteers were imaged with 3D fast spoiled gradient echo (FSPGR) T1-weighted Dixon, 3D FSPGR T1-weighted CHESS and 3D T1-weighted fast spin echo (FSE) CHESS sequences in a 1.5T MR scanner. Three radiologists scored the effectiveness of fat suppression in bone marrow (EFSBM) and soft tissues (EFSST) in 20 joints per subject. One radiologist measured the signal-to-noise ratio (SNR) in 10 bones per subject. Statistical analysis used two-way ANOVA with random effects (P<0.0083), paired t-test (P<0.05) and observed agreement to assess differences in effectiveness of fat suppression, differences in SNR and interobserver agreement. RESULTS: EFSBM was statistically significantly higher for the 3D FSPGR T1-weighted Dixon than for the 3D FSPGR T1-weighted CHESS sequence and the 3D FSE T1-weighted CHESS sequence (P<0.0001). EFSST was statistically significantly higher for the 3D FSPGR T1-weighted Dixon than for the 3D FSPGR T1-weighted CHESS sequence (P<0.0011) and for the 3D FSE T1-weighted CHESS sequence in the axial plane (P=0.0028). Mean SNR was statistically significantly higher for 3D FSPGR T1-weighted Dixon sequence than for 3D FSPGR T1-weighted CHESS and 3D FSE T1-weighted CHESS sequences (P<0.0001). CONCLUSION: The Dixon method yields more effective fat suppression and higher SNR than the CHESS technique at 3D T1-weighted MR imaging of the hands.

[Intravesical active prostate bleeding diagnosed in B-mode ultrasound]. / Saignement actif prostatique intravésical diagnostiqué en échographie mode B.

Hematuria is one of the most frequent minor complications after prostatic biopsy. We would like to report the case of a 68-year-old patient with massive hematuria after prostatic biopsy and intravesical active prostate bleeding diagnosed in B-mode ultrasonography.