PI-RADS v2.1 evaluation of prostate "nodule in nodule" variants: clinical, imaging, and pathological features.

OBJECTIVES: To analyze the correlation among the imaging features of prostate "nodule in nodule," clinical prostate indices, and pathology results. METHODS: We retrospectively analyzed the prostate images from 47 male patients who underwent MRI scans and pathological biopsy from January 2022 to July 2023. Two radiologists (R1/R2) evaluated the morphology and signal intensity of the "nodule in nodule" in a double-blind manner and calculated the PI-RADS v2.1 score, which was compared with clinical prostate indices and pathological results. RESULTS: 34.04% (16/47) of patients were pathologically diagnosed with clinically significant prostate cancer (csPCa). Total prostate-specific antigen (tPSA), free/t PSA, PSA density (PSAD), and prostate gland volume (PGV) were significantly different between csPCa patients and benign prostatic hyperplasia (BPH) patients with prostate "nodule in nodule". R1/R2 detected 17/17 prostate "nodule in nodule" pathologically confirmed as csPCa on MRI; 10.60% (16/151) (R1) and 11.11% (17/153) (R2) had diffusion-weighted imaging (DWI) PI-RADS v2.1 score of 4, and 0.66% (1/151) (R1) had a score of 3. The percentages of encapsulated, circumscribed, and atypical nodules and obscured margins were 0.00% (0/151), 0.00% (0/151), 5.96% (9/151), and 5.30% (8/151), respectively, for R1, and 0.00% (0/153), 0.00% (0/153), 5.88% (9/153), and 4.58% (7/153) for R2. CONCLUSION: When the inner nodules of "nodule in nodule" lesions in PI-RADS v2.1 category 1 in the TZ show incomplete capsulation or obscured margins, they are considered atypical nodules and might be upgraded to PI-RADS v2.1 category 3 if they exhibit marked diffusion restriction. However, further validation is needed. CRITICAL RELEVANCE STATEMENT: This study first analyzed the relationship between clinical and pathological findings and the size, margin, and multimodal MRI manifestations of the prostate "nodule in nodule." These findings could improve the diagnostic accuracy of PI-RADS v2.1 for prostate lesions. KEY POINTS: • The margin of the prostate inner nodules affects the PI-RADS v2.1 score. • The morphology of prostate "nodule in nodule" is related to their pathology. • The PI-RADS v2.1 principle requires consideration of prostate "nodule in nodule" variants.

MRI Plain Scan: A Tool in the Management of Cervical Cancer during Pregnancy.

OBJECTIVE: The purpose of this study was to assess the diagnostic value of magnetic resonance imaging (MRI) in staging and treatment of cervical cancer in pregnancy, and to evaluate the benefit of apparent diffusion coefficient (ADC) during neoadjuvant chemotherapy management. MATERIALS AND METHODS: This was a retrospective cohort study. Patients were divided into two groups according to the stage of cervical cancer. The mean term of pregnancy at the time of the diagnosis was the early second trimester (range 10-27 weeks) and the median age was 33 years (range 26-40 years). The abdominal and pelvic MRI images and clinical data of these patients were reviewed. Tumor size, local tumor spread, and nodal involvement were evaluated using an MRI dataset. The treatment and follow-up imaging were analyzed as well, and the ADC was measured before and after the chemotherapy. RESULTS: 16 patients with histopathologically confirmed cervical cancer during pregnancy were retrospectively enrolled. 7 patients were diagnosed with local cervical cancer (FIGO stage IAI) and designated as early stage group, as the lesion was invisible on MRI. In this group, pregnancies were allowed to continue until cesarean delivery (CD) at 38-41 weeks. The other 9 patients presenting with local or extensive cervical cancer (FIGO stage IB2-IIA2) were designated as the advanced-stage group. The lesion could be measured and analyzed on MRI. They were treated with neoadjuvant chemotherapy in pregnancy. Among them, 6 patients underwent TP regimen (paclitaxel 135~175 mg/m2 plus cisplatin 70~75 mg/m2), while 3 patients received TC regimen (paclitaxel 135~175 mg/m2 plus carboplatin AUC=5). NACT was performed for 1 to 2 courses before surgery. ADC demonstrated significant differences before and after chemotherapy administered during pregnancy (1.06 ± 0.12 sec/mm2 vs. 1.34 ± 0.21 sec/mm2). CONCLUSION: MRI has been found to be helpful in staging cervical cancer in pregnancy. Patients with stage IA confirmed by MRI can choose conservative treatment and continue the pregnancy until term birth. MRI can dynamically monitor the efficacy of chemotherapy for patients with stage IB and above during pregnancy. ADC value can have a potential role in the evaluation of chemotherapy efficacy.

Effect of different reconstruction algorithms on coronary artery calcium scores using the reduced radiation dose protocol: a clinical and phantom study.

BACKGROUND: This study aimed to evaluate the effects of different iterative reconstruction (IR) algorithms on coronary artery calcium (CAC) score quantification using the reduced radiation dose (RRD) protocol in an anthropomorphic phantom and in patients. METHODS: A thorax phantom, containing 9 calcification inserts with varying hydroxyapatite (HA) densities, was scanned with the reference protocol [120 kv, 80 mAs, filtered back projection (FBP)] and RRD protocol (120 kV, 20-80 mAs, 5 mAs interval) using a 256-slice computed tomography (CT) scanner. Raw data were reconstructed with different reconstruction algorithms [iDose4 levels 1-7 and iterative model reconstruction (IMR) levels 1-3]. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and Agatston score (AS) were calculated for each image series. The correction factor was derived from linear regression analysis between the reference image series and other image series with different parameters. Additionally, 40 patients were scanned with the RRD protocol (50 mAs) and reconstructed with FBP, iDose4 level 4, and IMR level 2. AS was calculated for the 3-group image series, and was corrected by applying a correction factor for the IMR group. The agreement of risk stratification with different reconstruction algorithms was also analyzed. RESULTS: For the phantom study, the iDose4 and IMR groups had significantly higher SNR and CNR than the FBP group (all P<0.05). There were no significant differences in the total AS after comparing image series reconstructed with iDose4 (level 1-7) and FBP (all P>0.05), while AS from the IMR (level 1-3) image series were lower than the FBP group (all P<0.05). The tube current of 50 mAs was determined for the clinical study, and the correction factor was 1.14. For the clinical study, the median AS from the iDose4 and IMR groups were both significantly lower compared to the FBP image series [(112.89 (63.01, 314.09), 113.22 (64.78, 364.95) vs. 118.59 (65.05, 374.48), both P<0.05]. After applying the correction factor, the adjusted AS from the IMR group was not significantly different from that of the FBP group [126.48 (69.62, 355.85) vs. 118.59 (65.05, 374.48), P=0.145]. Moreover, the agreement in risk stratification between FBP and IMR improved from 0.81 to 0.85. CONCLUSIONS: The RRD CAC scoring scan using the IMR reconstruction algorithm is clinically feasible, and a correction factor can help reduce the AS underestimation effect.

The relationship between TEM8 and early diagnosis and prognosis of lung cancer.

BACKGROUND: To explore the TEM8 expression in patients with lung cancer and its relationship with clinical pathology and prognosis, and to analyze the diagnostic value of TEM8. METHODS: A total of 204 patients with lung cancer diagnosed and treated in Zhongmeng Hospital Zhalantun and the First Affiliated Hospital of Jinzhou Medical University from March 2013 to February 2016 were enrolled in the study group, and 203 healthy subjects in the control group. qRT-PCR technique was applied to detect the TEM8 expression. Combined with clinical information, the diagnostic value of TEM8 for lung cancer and the correlation of clinical characteristics of TEM8 were analyzed. The 3-year survival curves of patients with low and high TEM8 expressions were compared. RESULTS: The expression in the study group was significantly higher than that in the control group (P<0.05). When the cut-off value was 1.125, the sensitivity, specificity and AUC of TEM8 in the diagnosis of lung cancer were 50.00%, 98.00% and 0.726 respectively. The TEM8 expression also differs when in smoking, lymphatic metastasis, TNM stage, differentiation degree and pleural invasion classification (P<0.050). 132 patients were included in the survival group and 72 patients were included in the death group. There was a difference between the two groups in the effect of TEM8 on the prognosis (P<0.001). CONCLUSIONS: TEM8 showed high expression in the study group. TEM8 had good diagnostic efficacy and was expected to be an excellent indicator for early clinical diagnosis and prognosis of lung cancer.

Optimization of Pan-Pim Kinase Activity and Oral Bioavailability Leading to Diaminopyrazole (GDC-0339) for the Treatment of Multiple Myeloma.

Pim kinases have been targets of interest for a number of therapeutic areas. Evidence of durable single-agent efficacy in human clinical trials validated Pim kinase inhibition as a promising therapeutic approach for multiple myeloma patients. Here, we report the compound optimization leading to GDC-0339 (16), a potent, orally bioavailable, and well tolerated pan-Pim kinase inhibitor that proved efficacious in RPMI8226 and MM.1S human multiple myeloma xenograft mouse models and has been evaluated as an early development candidate.

Single nucleotide polymorphisms in the CD40 gene associate with the disease susceptibility and severity in knee osteoarthritis in the Chinese Han population: a case-control study.

BACKGROUND: This study explored the association between single nucleotide polymorphisms (SNPs) in the CD40 gene, rs4810485 G > T and rs1883832 C > T, as well as disease susceptibility and severity in knee osteoarthritis (KOA) in the Chinese Han population. METHOD: Peripheral venous blood was collected from 133 KOA patients (KOA group) and 143 healthy people (control group) from December 2012 to November 2013. The patients in the KOA group were classified into mild, moderate and severe groups according to disease severity. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to test the genotypes of all subjects. Binary logistic regression analyses were performed to analyze the risk factors for KOA. RESULTS: The KOA group was significantly different from the control group in living environment (P < 0.05). The KOA group had a lower frequency of TT genotype and T allele distribution of rs4810485 G > T compared with the control group, and rs4810485 G > T TT genotype and T allele may associate with low incidence of KOA (all P < 0.05). Besides, T allele and mutant homozygous TT genotype of rs1883832 C > T increased the susceptibility to KOA. Genotype and allele distribution of rs4810485 G > T and rs1883832 C > T were significantly different among the mild, moderate and severe groups (P < 0.05). There were more patients with rs4810485 G > T GG genotype and rs1883832 C > T TT genotype in the severe group than other genotypes of these two SNPs. According to binary logistic regression analysis, rs4810485 G > T TT genotype could alleviate disease severity in KOA, rs1883832 C > T TT genotype increase the severity of KOA and living environment is an important external factor that affects KOA severity. CONCLUSIONS: These data provide evidences that rs4810485 G > T and rs1883832 C > T in the CD40 gene may be associated with disease susceptibility and severity in KOA.

[Clinical research of transvaginal repair of cesarean scar diverticulum].

OBJECTIVE: To explore the clinical effect of transvaginal repair of cesarean scar diverticulum (CSD). METHODS: Totally 64 patients of CSD in the First Maternity and Infant Hospital, Tongji University between Mar. 2013 and Sept. 2014 underwent transvaginal repair of CSD were reviewed retrospectively and followed. RESULT: All the patients had a prolonged period, and the duration was (14.8 ± 3.5) days; all the patients were received the transvaginal repair of CSD, there was no intra-operative complications, the procedures were successfully performed in all patients. The mean operation time was (67 ± 12) minutes, the mean blood loss was (53 ± 32) ml, and the mean length of hospital stay was (4.0 ± 1.1) days. All patients were followed after the operation, the duration of menstruation was (8.1 ± 3.5) days shorter in average, which was statistically significant (P < 0.01); the operation effective rate was 94% (60/64) to assess the clinic syptoms, the operation effective rate was 95% (61/64) for anatomic assessment. The distance of the CSD from the serosa became thicker after surgery significantly, the distance was thicker (3.4 ± 0.4) mm compared with preoperation (P < 0.01). CONCLUSIONS: Transvaginal repair of CSD offers minimal invasiveness, good exposure and accurate resection. It is worth to be popularized in the treatment of patients with CSD.

Craniofacial venous malformations: magnetic resonance imaging features that predict treatment outcome.

PURPOSE: Craniofacial venous malformations (VMs) are challenging lesions. Treatment is not routinely indicated unless the benefit and loss have been weighed properly. Therefore it is crucial to predict clinical outcome before treatment. This study was performed to retrospectively determine whether pretreatment magnetic resonance imaging (MRI) findings are predictive of outcome in patients who undergo sclerotherapy for craniofacial VMs. PATIENTS AND METHODS: MRI findings and clinical results of percutaneous sclerotherapy with ethanol and bleomycin A(5) in 69 patients with craniofacial VMs were retrospectively reviewed. Lesions were categorized with MRI based on margins; 51 were limited VMs, and 18 were infiltrating VMs. We performed t test analysis to assess the difference in the number of sclerotherapy sessions between the 2 groups. The Kruskal-Wallis test was used to evaluate differences in symptom improvement and satisfaction level between the groups. The difference in complication rates was assessed by chi(2) analysis. RESULTS: The better response to treatment was among the patients with limited VMs. The number of sclerotherapy sessions was 1.9 +/- 1.2 for limited VMs and 3.6 +/- 1.5 for infiltrating VMs, with a significant difference between the groups (P = .0001). The patients with limited VMs were significantly more likely to have better symptom improvement (P = .0001) and a higher satisfaction level (P = .0001). The complication rates of the limited and infiltrating VMs were 18.2% (18/99) and 32.8% (21/64), respectively. A significant difference was found between the groups (P = .033). CONCLUSIONS: The feature of lesion margin on MRI before sclerotherapy is an important predictor of treatment outcome for craniofacial VMs.

Design of a new histamine H3 receptor antagonist chemotype: (3aR,6aR)-5-alkyl-1-aryl-octahydropyrrolo[3,4-b]pyrroles, synthesis, and structure-activity relationships.

A new histamine H3 receptor (H3R) antagonist chemotype 1 was designed by combining key pharmacophoric elements from two different precursor structural series and then simplifying and optimizing the resulting combined structural features. First, analogues were made based on a previously identified conessine-based H3R antagonist series. While the first analogues 11 and 15 showed no antagonistic activity to H3R, the mere addition of a key moiety found in the reference compound 7 (ABT-239) elevated the series to high potency at H3R. The hybrid structure (16b) was judged too synthetically demanding to enable an extensive SAR study, thus forcing a strategy to simplify the chemical structure. The resulting (3aR,6aR)-5-alkyl-1-aryl-octahydropyrrolo[3,4-b]pyrrole series proved to be highly potent, as exemplified by 17a having a human H3 K(i) of 0.54 nM, rat H3 K(i) of 4.57 nM, and excellent pharmacokinetics (PK) profile in rats (oral bioavailability of 39% and t(1/2) of 2.4 h).

Noncontrast three-dimensional magnetic resonance imaging vs lymphoscintigraphy in the evaluation of lymph circulation disorders: A comparative study.

BACKGROUND: Visualization of the lymphatic vessels is a challenge in patients with disorders of the lymphatic circulation. In an effort to improve the diagnostic scope of lymphatic imaging, we compared traditional lymphoscintigraphy (LSG) with three-dimensional magnetic resonance imaging (3D MRI). METHODS: From October 1, 2002, to May 30, 2004, 39 patients (27 males and 12 females) with lower extremity lymphedema and/or skin lymphorrhea in the abdominal wall or the external genitalia underwent LSG and 3D MRI. Patients' ages ranged from 3 to 71 years. Assessment of the imaging studies included the degree and quality of visualization of the malformations of the lymphatic collectors, lymphatic trunks, lymph nodes, and tissue edema. RESULTS: In patients with lymphedema, chylous reflux syndrome, or both, LSG depicted the enlarged lymphatics and nodes as a fused band or mass. In 3D MRI, the dilated superficial lymphatic collectors and deep lymphatic trunks, as well as the accumulation of chyle and node enlargements, were clearly visualized. In patients with hypoplasia or aplasia of the lymphatics, LSG usually displayed the pattern of dermal backflow in the form of radiotracer filling of the dermal lymphatics or stagnation of the isotope at the injection point. The images obtained by 3D MRI were able to demonstrate the extent of tissue fluid accumulation and distinguish edema fluid from subcutaneous fat. CONCLUSIONS: In patients with peripheral and central lymphatic malformations, LSG provided images representative of the function of the lymphatic vessels but failed to give detailed information regarding its anatomy. 3D MRI provided extensive information on the anatomy of the lymph stagnated vasculature as well as on the effects of lymphatic dysfunction on local structures and tissue composition.