Initial findings using high-resolution magnetic resonance imaging for visualisation of the sural nerve and surrounding anatomy in healthy volunteers at 7 Tesla.

BACKGROUND AND AIMS: Histopathological diagnosis is the gold standard in many acquired inflammatory, infiltrative and amyloid based peripheral nerve diseases and a sensory nerve biopsy of sural or superficial peroneal nerve is favoured where a biopsy is deemed necessary. The ability to determine nerve pathology by high-resolution imaging techniques resolving anatomy and imaging characteristics might improve diagnosis and obviate the need for biopsy in some. The sural nerve is anatomically variable and occasionally adjacent vessels can be sent for analysis in error. Knowing the exact position and relationships of the nerve prior to surgery could be clinically useful and thus reliably resolving nerve position has some utility. METHODS: 7T images of eight healthy volunteers' (HV) right ankle were acquired in a pilot study using a double-echo in steady-state sequence for high-resolution anatomy images. Magnetic Transfer Ratio images were acquired of the same area. Systematic scoring of the sural, tibial and deep peroneal nerve around the surgical landmark 7 cm from the lateral malleolus was performed (number of fascicles, area in voxels and mm2, diameter and location relative to nearby vessels and muscles). RESULTS: The sural and tibial nerves were visualised in the high-resolution double-echo in steady-state (DESS) image in all HV. The deep peroneal nerve was not always visualised at level of interest. The MTR values were tightly grouped except in the sural nerve where the nerve was not visualised in two HV. The sural nerve location was found to be variable (e.g., lateral or medial to, or crossing behind, or found positioned directly posterior to the saphenous vein). INTERPRETATION: High-resolution high-field images have excellent visualisation of the sural nerve and would give surgeons prior knowledge of the position before surgery. Basic imaging characteristics of the sural nerve can be acquired, but more detailed imaging characteristics are not easily evaluable in the very small sural and further developments and specific studies are required for any diagnostic utility at 7T.

The value of semiquantitative analysis in identifying diffuse bone marrow involvement in follicular lymphoma.

AIM: The aim of the study was to investigate the value of fluorine-18-fluorodeoxyglucose ((18)F-FDG)-PET/computed tomography (CT) in identifying diffuse bone marrow (BM) involvement in follicular lymphoma using semiquantitative assessment. METHODS: This is a retrospective analysis of 41 patients with grade 1-3a follicular lymphoma who underwent (18)F-FDG-PET/CT, contrast-enhanced CT and bone marrow trephine biopsy (BMB) as part of staging. BM involvement on PET/CT was assessed by visual and semiquantitative analysis. Standardized uptake values (SUVmax) were measured at the sternum, at both iliac blades and at the T12 vertebra. An average of these four measurements was recorded as SUVav. The single highest overall SUVmax for the four bone sites, the SUVav and the ratios SUVav/mediastinal blood pool (MBP) and SUVav/liver were compared with the BMB result. RESULTS: Focal bone uptake was identified on (18)F-FDG-PET/CT by visual analysis in six patients, including two cases in which the BMB was negative. Assessment of diffuse BM involvement on (18)F-FDG-PET/CT by visual analysis had a sensitivity and specificity of 31 and 92%, respectively. Semiquantitative analysis resulted in an improved sensitivity and specificity of 58 and 96%, respectively, when using SUVav greater than or equal to 2 as the cutoff. Using the ratio SUVav/MBP greater than or equal to 1 the sensitivity of (18)F-FDG-PET/CT to detect BM involvement improved to 83%. CONCLUSION: Visual analysis is useful in determining focal bone involvement, whereas semiquantitative analysis using SUVav/MBP has a high sensitivity and specificity for predicting BM involvement in patients lacking focal bone lesions.

Airway deposition of nebulized gene delivery nanocomplexes monitored by radioimaging agents.

Receptor-targeted nanocomplexes are nonviral vectors developed for gene delivery to the airway epithelium for the treatment of pulmonary disease associated with cystic fibrosis. The present study aimed to optimize the delivery of the nanocomplex by nebulization, and to monitor the in vivo deposition of radiolabeled vector in the airways of a large animal model by γ-camera scintigraphy. Large White weaner pigs were nebulized with nanocomplexes mixed with technetium-99m radiopharmaceuticals. The aerosol deposition scans suggested that the nebulized radiovectors were deposited mainly in the trachea-main bronchi and in the midregion of the lungs. The plasmid biodistribution, assessed by real-time PCR, correlated with the scintigraphy images. The highest plasmid copy numbers were found in the bronchial areas and in the tissues proximal to the main bronchi bifurcation. Immunohistochemistry detected transgene expression in the tracheal and bronchial ciliated epithelium. Histological analysis of lung tissue showed no evidence of inflammation, and no increase in inflammatory cytokines or inflammatory cells was detected in the bronchoalveolar lavage. The deposition of nebulized nanocomplexes coassociated with technetium-99m can be monitored by nuclear medicine techniques. The use of a noninvasive strategy to follow the delivery of the vector could improve the clinical management of patients undergoing cystic fibrosis gene therapy.