Hypomethylation in HBV integration regions aids non-invasive surveillance to hepatocellular carcinoma by low-pass genome-wide bisulfite sequencing.

BACKGROUND: Circulating cell-free DNA (cfDNA) methylation has been demonstrated to be a promising approach for non-invasive cancer diagnosis. However, the high cost of whole genome bisulfite sequencing (WGBS) hinders the clinical implementation of a methylation-based cfDNA early detection biomarker. We proposed a novel strategy in low-pass WGBS (~ 5 million reads) to detect methylation changes in circulating cell-free DNA (cfDNA) from patients with liver diseases and hepatocellular carcinoma (HCC). METHODS: The effective small sequencing depth were determined by 5 pilot cfDNA samples with relative high-depth WGBS. CfDNA of 51 patients with hepatitis, cirrhosis, and HCC were conducted using low-pass WGBS. The strategy was validated in an independent WGBS cohort of 32 healthy individuals and 26 early-stage HCC patients. Fifteen paired tumor tissue and buffy coat samples were used to characterize the methylation of hepatitis B virus (HBV) integration regions and genome distribution of cfDNA. RESULTS: A significant enrichment of cfDNA in intergenic and repeat regions, especially in previously reported HBV integration sites were observed, as a feature of cfDNA and the bias of cfDNA release. Methylation profiles nearby HBV integration sites were a better indicator for hypomethylation of tumor genome comparing to Alu and LINE (long interspersed nuclear element) repeats, and were able to facilitate the cfDNA-based HCC prediction. Hypomethylation nearby HBV integration sites (5 kb flanking) was detected in HCC patients, but not in patients with hepatitis and cirrhosis (MethylHBV5k, median:0.61 vs 0.72, P = 0.0003). Methylation levels of integration sites certain candidate regions exhibited an area under the receiver operation curve (AUC) value > 0.85 to discriminate HCC from non-HCC samples. The validation cohort achieved the prediction performance with an AUC of 0.954. CONCLUSIONS: Hypomethylation around viral integration sites aids low-pass cfDNA WGBS to serve as a non-invasive approach for early HCC detection, and inspire future efforts on tumor surveillance for oncovirus with integration activity.

Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis.

BACKGROUND: It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in decompensated liver cirrhotic ascites patients (DCPs). The aim of the study was to measure serum procalcitonin (PCT) levels and peripheral blood leukocyte/platelet (WBC/PLT) ratios to obtain an early diagnostic indication of SBP in DCPs. METHODS: Our cohort of 129 patients included 112 DCPs (94 of whom had infections) and 17 cases with compensated cirrhosis as controls. Bacterial cultures, ascitic fluid (AF) leukocyte and peripheral WBC/PLT counts, and serum PCT measurements at admission were carried out prior to the use of antibiotics. Receiver operating characteristic (ROC) curves were generated to test the accuracies and cut-off values for different inflammatory markers. RESULTS: Among the 94 infected patients, 66 tested positive by bacterial culture, for which the positivity of blood, ascites and other secretions were 25.8%, 30.3% and 43.9%, respectively. Lung infection, SBP and unknown sites of infection accounted for 8.5%, 64.9% and 26.6% of the cases, respectively. Serum PCT levels (3.02 ± 3.30 ng/mL) in DCPs with infections were significantly higher than those in control patients (0.15 ± 0.08 ng/mL); p < 0.05. We used PCT ≥0.5 ng/mL as a cut-off value to diagnose infections, for which the sensitivity and specificity was 92.5% and 77.1%. The area under the curve (AUC) was 0.89 (95% confidence interval: 0.84-0.91). The sensitivity and specificity were 62.8% and 94.2% for the diagnosis of infections, and were 68.8% and 94.2% for the diagnosis of SBP in DCPs when PCT ≥2 ng/mL was used as a cut-off value. For the combined PCT and WBC/PLT measurements, the sensitivity was 76.8% and 83.6% for the diagnosis of infections or SBP in DCPs, respectively. CONCLUSION: Serum PCT levels alone or in combination with WBC/PLT measurements seem to provide a satisfactory early diagnostic biomarker in DCPs with infections, especially for patients with SBP.

Novel Signaling Pathway and NSC689534 as a Potential Drug Candidate for Cutaneous Squamous Cell Carcinoma.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the second most common malignancy of the skin, and its incidence is increasing annually. Once cSCC becomes metastatic, its associated mortality rate is much higher than that of cSCC in situ. However, the current treatments for progressive cSCC have several limitations. The aim of this study was to suggest a potential compound for future research that may benefit patients with cSCC. METHODS: In this study, we screened the following differentially expressed genes from the Gene Expression Omnibus database: GSE42677, GSE45164, GSE66359, and GSE98767. Using strategies such as protein-protein interaction network analysis and the CYTOSCAPE plugin MCODE, key modules were identified and then verified by Western blotting. Subsequently, related signalling pathways were constituted in the SIGNOR database. Finally, molecular docking analyses and cell viability assay were used to identify a potential candidate drug and verify its growth inhibition ability to A431 cell line. RESULTS: Fifty-one common differentially expressed genes were screened and two key modules were identified. Among them, three core genes were extracted, constituting two signalling pathways, both of which belong to the module associated with mitotic spindles and cell division. A pathway involving CDK1, the TPX2-KIF11 complex, and spindle organization was validated in a series of analyses, including analyses for overall survival, genetic alteration, and molecular structure. Molecular docking analyses identified the pyridine 2-carbaldehyde thiosemicarbazone (NSC689534), which interacts with TPX2 and KIF11, as a potential candidate for the treatment of cSCC. CONCLUSIONS: NSC689534 might be a candidate drug for cSCC targeting TPX2 and KIF11, which are hub genes in cSCC.

Predictive value of pre-procedural autoantibodies against M2-muscarinic acetylcholine receptor for recurrence of atrial fibrillation one year after radiofrequency catheter ablation.

BACKGROUND: Increasing evidences have suggested that autoantibodies against muscarinic-2 acetylcholine receptor (anti-M2-R) may play an important role in the development of atrial fibrillation (AF). Predictive value of pre-procedural anti-M2-R for the recurrence of AF after radiofrequency catheter ablation is still unclear. METHODS: Totally 76 AF patients with preserved left ventricular systolic function were prospectively enrolled and subjected to ablation after the detection of serum anti-M2-R by enzyme linked immunosorbent assay. These patients were given follow-up examination for one year after ablation. Risk estimation for the recurrence of AF was performed using the univariate and multivariate logistic regression. RESULTS: In AF group, serum anti-M2-R was significantly higher than that in the control group in terms of frequency (40.8% versus 11.7%; p < 0.001) and titer (1:116 versus 1:29; p < 0.001). Compared with paroxysmal AF patients, persistent AF patients had higher frequency (57.6% versus 27.9%; p = 0.009) and titer (1:132 versus 1:94; p = 0.012) for autoantibodies. During one-year follow-up examination after ablation, the recurrence of AF was observed in 25 (32.9%) patients. Multivariate analysis showed that pre-procedural serum anti-M2-R was an independent predictor for the recurrence of AF at the time point of 12 months after ablation (odds ratio: 4.701; 95% confidence interval: 1.590-13.894; p = 0.005). CONCLUSIONS: In AF patients, the frequency and titer of serum anti-M2-R were significantly higher than those in the control group with sinus rhythm. Pre-procedural serum anti-M2-R was an independent predictor for the recurrence of AF one year after radiofrequency catheter ablation.

HBsAg loss is not an ideal indicator for discontinuing treatment of HBeAg-negative chronic hepatitis B: a case report.

We experienced a case of a 36-year-old married man who was found to be hepatitis B virus (HBV) positive at 23 years of age. His liver function was repeatedly abnormal in the past 13 years. In November 2007 he presented with fatigue. Laboratory tests showed serum alanine aminotransferase concentration 255.3 U/l, positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antibody, HBV DNA 3.01 × 10(7) copies/ml; liver biopsy showed necroinflammatory scores 11 and fibrosis scores 4. After 20 weeks of treatment with Peg-IFN α-2b, laboratory tests showed HBV DNA <500 copies/ml and normal liver function. By week 52 of the treatment, HBsAg became negative. By week 92 of continuing treatment, HBsAb became weakly positive and Peg-IFN α-2b treatment was stopped. On follow-up, both HBsAg and HBsAb were negative 28 weeks after discontinuation of Peg-IFN α-2b. We then performed a second liver biopsy and histological examination revealed necroinflammtary scores 2 and fibrosis scores 2. We administered hepatitis B vaccine intramuscularly every 4 weeks combined with IFN α-1b 30 µg intramuscularly every other day. HBsAb was 244.8 IU/l at week 32 of this combined treatment. Follow-up showed that after discontinuation of the combined treatment HBsAb concentration declined rapidly but could be maintained above 100 IU/l by intermittent injections of hepatitis B vaccine. Findings from this case reveal that HBsAg loss may be not sufficient; however, HBsAg seroconversion together with maintenance of certain concentrations of HBsAb may be a better endpoint to HBV treatment.

Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case-Control Study.

BACKGROUND: Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP). METHODS: This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites. RESULTS: Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-ß-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985). CONCLUSIONS: SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.

Epidemiology and genotypic characteristics of carbapenem resistant Enterobacterales in Henan, China: a multicentre study.

OBJECTIVES: To identify the carbapenemase and colistin resistance genes and epidemiological status of carbapenem-resistant Enterobacterales (CRE) among 7 secondary and 11 tertiary hospitals in Henan province, China. METHODS: CRE isolates and clinical data of infected patients were collected from 7 secondary and 11 tertiary hospitals in Henan from July to September 2019 and analysed retrospectively. Polymerase chain reaction (PCR) and gene sequencing were performed to detect carbapenemase and colistin resistance genes; multilocus sequence typing was also performed. RESULTS: In total, 238 nonduplicate CRE isolates were collected mainly from the respiratory tract (54.20%) and blood (18.91%) of CRE-infected patients, half of them aged >65 years (45.80%). Carbapenem-resistant Klebsiella pneumoniae (CRKP) was the most common CRE (184 isolates, 77.31%) with constituent ratios of 84.38% and 72.54% in secondary and tertiary hospitals, respectively. In 184 CRKP isolates, blaKPC-2 (89.13%) was the dominant carbapenemase gene, and ST11 (71.74%) was the most prevalent sequence type (ST), with constituent ratios of 83.95% and 62.14% in secondary and tertiary hospitals, respectively. In 29 carbapenem-resistant Escherichia coli (CREC) isolates, blaNDM-5 (58.62%) and ST2 (31.03%) were prevalent. Four CRKP isolates and one CREC isolate were colistin-resistant and carried the plasmid-mediated mcr-1 gene. CONCLUSION: Our results showed a wide spread of CRKP-ST11 with KPC-2 carbapenemase in the analysed 18 hospitals. The CRKP constituent ratio, CRKP-STs, and CREC carbapenemase genes between secondary and tertiary hospitals showed significant differences. The emergence of a colistin-resistant CRKP with plasmid-mediated resistance gene mcr-1 is of serious concern due to the limited treatment options.

Integrated analysis from multi-center studies identities m7G-derived modification pattern and risk stratification system in skin cutaneous melanoma.

The m7G modification has been proven to play an important role in RNA post-transcriptional modification and protein translation. However, the potential role of m7G modification patterns in assessing the prognosis of Skin cutaneous melanoma (SKCM) and tumor microenvironment (TME) has not been well studied. In this study, we investigated and finally identified 21 available m7G-related genes. We used hierarchical clustering (K-means) to classify 743 SKCM patients into three m7G-modified subtypes named m7G/gene cluster-A, B, C. We found that both m7G cluster B and gene cluster B exhibited higher prognosis and higher immune cell infiltration in TME compared to other subtypes. EIF4E3 and IFIT5, two m7G related genes, were both markedly elevated in Cluster B. Then, we constructed an m7G score system utilizing principal component analysis (PCA) in order to evaluate the patients' prognosis. High m7G score subtype was associated with better survival prognosis and active immune response. Overall, this article revealed that m7G modification patterns were involved in the development of the tumor microenvironment. Evaluating patients' m7G modification patterns will enhance our understanding of TME characteristics and help to guide personal treatment in clinics in the future.

Molecular Mechanism of Polymyxin Resistance in Multidrug-Resistant Klebsiella pneumoniae and Escherichia coli Isolates from Henan Province, China: A Multicenter Study.

PURPOSE: To evaluate polymyxin-resistant Klebsiella pneumoniae and Escherichia coli prevalence and characteristics in the Henan province, China. MATERIALS AND METHODS: A total of 2301 bacterial isolates collected at six hospitals were assessed. Their response to polymyxin was evaluated by minimum inhibitory concentration (MIC) analysis, and the mobilized colistin resistance (mcr) and carbapenemase gene were explored. Mutations on mgrB, phoPQ, pmrAB, and crrAB in polymyxin-resistant K. pneumoniae were detected by PCR. phoP, phoQ, pmrK, pmrA, pmrB, and pmrC transcriptional levels were quantified by RT-qPCR. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing were performed to determine the phylogenetic relationship between the polymyxin-resistant isolates. RESULTS: Of the E. coli and K. pneumoniae isolates identified, 0.3% and 1.4% were polymyxin-resistant, respectively, with MICs of 4-64 µg/mL. All polymyxin-resistant isolates were susceptible to tigecycline. Four E. coli isolates were mcr-1-positive and one was carbapenem-resistant, carrying bla NDM-5 and mcr-1. One K. pneumoniae isolate was mcr-1-positive and nine were carbapenem-resistant (PRCRKP), carrying bla KPC-2 but not mcr-1. The five E. coli isolates belonged to four sequence types (ST2, ST132, ST632, and ST983). All PRCRKP isolates belonged to ST11. However, all 16 isolates belonged to different PFGE types with <95% genetic similarity. Insertion sequences in mgrB were detected in nine (81.8%) polymyxin-resistant K. pneumoniae samples. Colistin resistance was linked with pmrHFIJKLM operon upregulation, with phoP, phoQ, and pmrK being overexpressed in all but one of the polymyxin-resistant K. pneumoniae samples. Furthermore, 33.3% of patients carrying polymyxin-resistant isolates had previously used polymyxin, and 66.7% patients displayed good clinical outcomes. CONCLUSION: The K. pneumoniae polymyxin resistance rate was slightly higher than that of E. coli and mcr-1 was more common in E. coli than in K. pneumoniae. Moreover, the insertion of ISkpn14 into mgrB may be the main contributor to polymyxin-resistance in K. pneumoniae in Henan.

[Perfusion characteristics of normal renal cortex with 64-slice spiral CT].

OBJECTIVE: To evaluate perfusion characteristics of normal renal cortex with 64-slice spiral CT and to investigate the correlation between perfusion parameters and gender, age, and serum creatinine (Scr). METHODS: In total 71 healthy subjects, the kidney non-enhanced imaging and perfusion imaging with 64-slice spiral CT were performed. Perfusion parameters of renal cortex including blood flow (BF), blood volume (BV), and permeability (PM) were calculated with Siemens Body PCT (VB20B) software. The differences of BF, BV and PM in different age and gender people were compared by one-way ANOVA. The correlation between age and perfusion parameters, Scr, and PM were analyzed. RESULTS: Technical failures were experienced in 3 (3/71, 4.2%) subjects. Perfusion values of normal renal cortex in male, female, and all subjects were obtained separately. Male subjects (n = 56): BF = (229.8 +/- 49.9) ml/(100 ml x min), BV = (398.2 +/- 59.5) 1000:1, PM = (213.5 +/- 54.0) 0.5 ml/(100 ml x min); female subjects (n = 52): BF = (230.0 +/- 56.1) ml/(100 ml x min) BV = (358.1 +/- 49.7) 1000:1, PM = (186.2 +/- 32.1) 0.5 ml/(100 ml x min); all subjects (n = 108): BF = (229.9 +/- 52.7) ml/(100 ml x min), BV = (378.9 +/- 58.4) 1000:1, PM = (200.4 +/- 46.7) 0.5 ml/(100 ml x min). There was no significant difference in BF (F = 0.367, P = 0.547), BV (F = 3.088, P = 2.762), and PM (F = 3.308, P = 0.074) between male and female. In male, female, and all subjects, BF were all negatively correlated with age (r = -0.484, r = -0.429, r = -0.425; P < 0.01), while there was no correlation between BV (r = -0.152, r = -0.243, r = -0.043, P > 0.05) and PM (r = 0.053, r = 0.123, r = 0.172, P > 0.05) and age. There was no correlation between PM and Scr (r = 0.064, P > 0.05). CONCLUSION: The measurement of normal renal cortical perfusion characteristics with 64-slice spiral CT is feasible and can be used for the quantitative evaluation of the physiological functions of normal renal cortex.

[Perfusion characteristics of renal tumor and volume of normal kidney before and after arterial embolization on 64-slice spiral CT].

OBJECTIVE: To investigate the perfusion characteristics and compare the volume of normal kidney and serum creatinine (Scr) before and after arterial embolization on 64-slice spiral CT. METHODS: Totally 21 patients with renal tumor were enrolled. Sixty-four slice spiral CT was used for renal perfusion scan before and after patients underwent tumor arterial embolization. Perfusion characteristics, including blood flow, blood volume, and permeability of renal mass parenchyma and renal cortex in normal kidneys were calculated and the volume of normal kidneys was measured. The values of Scr in all patients were recorded. The perfusion characteristics, the volume of normal kidneys and the level of Scr before and after embolization were compared. RESULTS: Renal clear cell carcinoma was pathologically confirmed in all patients. After having supply blood arterial embolization of renal tumor, perfusion characteristics of tumor parenchyma significantly decreased, perfusion characteristics of renal cortex in normal kidney significantly increased, and the volume of normal kidneys was significantly enlarged (P < 0.01); however, the values of Scr in all patients were not significantly different (P > 0.05). CONCLUSIONS: The perfusion characteristics and volume of kidney may reflect the effects of renal arterial embolization on renal function. Perfusion imaging with multi-slice spiral CT is potentially useful in the evaluation of renal pathophysiological characteristics.

[Radiological features of dual-energy CT lung perfusion imaging in patients with acute pulmonary embolism: comparison with CT pulmonary angiography].

OBJECTIVE: To explore the relationship of the perfusion defects in the dual-energy CT lung perfusion image and the filling defects in the CT pulmonary angiography (CTPA) in patients with acute pulmonary embolism. METHODS: The clinical data of 22 patients with acute pulmonary embolism were retrospectively analyzed. All of them underwent contrast CT scan in two phases using dual-energy CT: the first is pulmonary artery phase, and the second was performed immediately after the first phase using dual-energy scan covered the whole lung. Perfusion defects in the lung perfusion images were compared with the filling defects in the CTPA. RESULTS: Complete filling defects of segmental and subsegmental pulmonary arteries mostly showed correspondence perfusion defects in the CT perfusion map, accounting for 83% and 62% respectively. However, when there were partial or central filling defects, most of them were partial perfusion defects or normal in the CT perfusion map. Three segmental perfusion defects were depicted without the visualization of endoluminal thrombi within the corresponding arteries. CONCLUSIONS: The perfusion defects in the CT lung perfusion image are not completely corresponding to the filling defects in the CTPA. The combination of CTPA and CT lung perfusion map will offer more information for the acute pulmonary embolism.

[Dual-energy CT angiography for evaluation of internal carotid artery stenosis and occlusion].

OBJECTIVE: To compare the feasibility of bone and calcified plaque subtracted dual-energy CT angiography (CTA) with time of flight magnetic resonance angiography (TOF MRA) in evaluation of internal carotid artery atherosclerosis. METHODS: Totally 32 patients received a dual-energy CTA scan, along with a cerebral TOF MRA scan before or after CTA examination from one day to one month. Dual-energy software was used for bone and calcified plaque subtraction. Five anatomical segments were described for each internal carotid artery according to Fischer (1938). Ratings were based on a 1-4 scale for the dual-energy CTA maximum intensity projection (MIP) image: 1 not diagnostic, 2 partially diagnostic, 3 diagnostic, and 4 excellent. Lesions were categorized as mild (0-29%), moderate (30%-69%), severe (70%-99%), or occluded (no flow detected). Stenosis of internal carotid artery was evaluated based on post-subtracted CTA images and TOF MRA images. RESULTS: In 320 arterial segments, 99% of arterial segments were > or = 3 score. Grading of stenosis on dual-energy CTA agreed with grading of stenoses on MRA images in 98% of arteries. In the mild and occlusion group, the agreement was 100% respectively. In the moderate and severe group, dual-energy CTA showed more severe stenosis than MRA in 7 vessels and there was significant difference between the results from the two different modalities (Z = -3.071, P = 0.002). CONCLUSION: Dual-energy CTA can be used to assess the stenosis of internal arteries around skull base, but may exaggerate the severe stenosis of cerebral arteries compared with TOF MRA.

Spectrum of functioning islet cell tumor on multislice computed tomography: experience on 70 patients.

OBJECTIVE: To review experience in preoperative detection of islet cell tumors using multislice computed tomography (MSCT) and summarize various imaging features of functioning islet cell tumors on enhanced MSCT. METHODS: Seventy patients with clinical or pathological diagnosis of functioning pancreatic islet cell tumor between October 2003 and February 2007 were included in this retrospective study. Seventy-four enhanced MSCT scans in these patients were identified. All MSCT scans were interpreted by two experienced radiologists by consensus interpretation. Surgery and pathology reports were used to confirm the diagnosis, localization, and size of tumors. RESULTS: Totally, 73 functioning islet cell tumors including 65 benign insulinomas, 2 benign glucagonomas, 3 malignant insulinomas, and 3 malignant glucagonomas were pathologically diagnosed. Tumors in only two cases were not found by MSCT. In 67 benign lesions, 32 showed typical enhancement style, 21 showed prolonged enhancement in portal venous phase, 4 showed delayed enhancement, 4 had iso-dense enhancement with normal pancreatic parenchyma, 2 had no enhancement at all in arterial phase and portal venous phase, and 4 had inhomogeneous enhancement with necrosis or cyst-formation. Patchy or spotty calcifications were found in 3 of the 67 tumors. In 6 malignant islet cell tumors, vessel invasion (2/6) and bowel invasion (1/6) were seen. Different enhancement patterns were shown. All hepatic metastases showed hyper-enhancement during their arterial phase. CONCLUSIONS: Pancreatic islet cell tumor may display a wide spectrum of presentations in MSCT. Tumors with unusual appearances often present as diagnostic challenges. Non-contrast and post-contrast multiphase scans are recommended for the localization of functioning islet cell tumors.

[Perfusion characteristics of renal mass with 64-slice spiral computed tomography].

OBJECTIVE: To investigate the perfusion characteristics of renal mass parenchyma on 64-slice spiral computed tomography (CT). METHODS: Totally 91 patients with renal mass were enrolled. Sixty-four slice spiral CT was used for renal perfusion scan that began with a contrast bolus injection of 50 ml (370 mgI/ml) at a rate of 5 ml/s. Perfusion characteristics, including blood flow (BF), blood volume (BV), and permeability (PM) of renal mass parenchyma and renal cortex in affected and normal kidneys were calculated from Siemens Body PCT (VB20B) software, and the perfusion characteristics among renal mass parenchyma and renal cortex in affected and normal kidneys were compared. RESULTS: Renal clear cell carcinoma (RC-CC), renal pelvic transitional cell carcinoma (RPTCC), and renal angiomyolipoma (RAML) was pathologically confirmed in 40, 21, and 16 patients, respectively, while the remaining 14 patients were diagnosed as with renal simple cyst (RSC). Technical failure was experienced in 1 (1.1% ) patient. Perfusion parameters of tumor parenchyma were measured as follow: RCCC, BF (93.7 +/- 20.2) ml x (100 ml)(-1) x min(-1), BV (182.0 +/- 46.6) 1000:1, PM (115.7 +/-30.2) 0.5 ml x (100 ml)(01) x min(-1); RPTCC, BF (48.0 +/- 21.2) ml x (100 ml)(-1) x min(-1), BV (82.4 +/- 29.7) 1000:1, PM (65.7 +/- 17.2) 0.5 ml (100 ml)(-1) x min(-1); RAML, BF (52.6 +/- 18.5) ml x (100 ml)(-1) x min(-1), BV (110.1 +/- 45.9) 1000:1, PM (60.1 +/- 23.0) 0.5 ml x (100 ml)(-1) x min-1; RSC, BF (7.0 +/- 6.5) ml x (100 ml)(-1) min(-1), BV (16.2 +/- 9.7) 1000:1, PM (12.0 +/- 7.2) 0.5 ml x (100 ml) (-1) x min(-1). In all pathological groups, perfusion pa- rameters showed significant differences (P <0 . 1) between mass parenchyma and renal cortex in affected kidney, while there were no significant differences (P > 0. 5) in perfusion characteristics between renal cortex in affected and normal kidneys. Aslo, the perfusion characteristics were significantly different between parenchyma D in any two kinds of renal masses (P <0 . 5) except for RPTCC and RAML (P > 0. 5). C ONCLUSIONS: fDif-rent pathological types of renal mass have different perfusion characteristics. Perfusion imaging with multislice CT is potentially useful in the differential diagnosis of renal mass.

Coronary angiography with dual source computed tomography: initial experience.

OBJECTIVE: To explore the scan technique and image quality of coronary angiography with dual source computed tomography (CT) without oral metoprolol preparation. METHODS: Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients. Calcium scoring with plain scan images as well as multi-planar reconstruction (MPR), maximum intensity projection (MIP), and volume rendering technique (VRT) reconstruction with enhanced scan images were performed in all cases. The scan technique and post-reconstruction experience was summarized. The image quality was classified as 1 to 4 points, and coronary segments classified according to the American Heart Association standards were evaluated. RESULTS: The average calcium score of the 600 cases was 213.6 +/- 298.7 (0-3,216.5). The average heart rate of the enhanced scan was 82.1 +/- 16.2 (47-139) bpm. The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method, two or more phases supplemented method, and electrocardiogram editing method. Altogether 8,457 coronary segments were evaluated, among which 97.2% were evaluated as point 1, 1.7% point 2, 0.5% point 3, and 0.6% point 4. The coronary segments in 261 cases were completely normal, while 360 segments were diagnosed with < 50% stenosis and 625 segments with > or = 50% stenosis. CONCLUSIONS: Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation. Heart rate is not a major source of the artifact, coronary segments can be well shown with single or multiple-phase reconstruction method.

Retrospective analysis of magnetic resonance myocardial delayed enhancement.

OBJECTIVE: To explore the imaging and related clinical characteristics of magnetic resonance (MR) delayed enhancement in patients with ischemic or nonischemic heart disease. METHODS: Thirty-two cases who underwent MR myocardial cine and delayed enhancement imaging from January 2004 to October 2006 were retrospectively analyzed. The cine sequence imaging included the four-chamber view and the left ventricular short axis view. The delayed enhancement imaging was taken 10 minutes after the infusion of gadolinium from the antecubital vein with a segmented inversion-recovery-prepared T1-weighted fast gradient echo sequence. Patients underwent coronary computed tomography angiography (CTA) two weeks before or after the MR imaging examination. Combined with clinical history, the clinical and MR imaging characteristics of the patients who had delayed enhancement were analyzed. RESULTS: MR delayed enhancement could be found in 16 cases. Among them, 12 cases had ischemic heart disease. Their coronary CTA showed one to three vessel diseases. The delayed enhancement was transmural or subendocardium, and the area of delayed enhancement corresponded well with one or more coronary arteries which had severe stenosis or occlusion. Four cases had nonischemic heart diseases. One case was dilated cardiomyopathy, with diffuse small midwall spots in delayed enhancemen and only 30% stenosis of the anterior descending coronary artery in coronary CTA. One case was hypertrophic cardiomyopathy, with delayed enhancement of strip- and patch-shaped at midwall of the hypertrophic myocardium. One case was restrictive cardiomyopathy, and the delayed enhancement was located in the area of subendocardium of both the right and left ventricles. Coronary CTA of these two cases were normal. The other case was a mass of the lateral wall of the left ventricle, and the delayed enhancement with a clumpy shape was located in the lateral wall of the left ventricle. CONCLUSIONS: MR myocardial delayed enhancement is not a specific sign of myocardial infarction of ischemic heart disease. Nonischemic heart diseases including all kinds of primary cardiomyopathy and some other diseases affecting myocardium can also cause delayed enhancement, but their characteristics are different. The differentiation of the etiology of the nonischemic heart disease with delayed enhancement relies upon the intimate connection with clinical history and the cine sequence MR images.

[Perfusion characteristics of normal pancreas and insulinoma on multi-slice spiral CT].

OBJECTIVE: To investigate the perfusion characteristics of normal pancreas and insulinoma on multi-slice spiral CT (MSCT). METHODS: Totally 21 subjects with suspected insulinoma were enrolled. Sixteen-slice spiral CT was used for perfusion scan following a standard contrast-enhanced scan. The surgical and pathological outcomes were collected for comparison. Perfusion characteristics, including blood flow (BF), patlak blood volume (pBV), time to peak (TTP), permeability, and peak enhancement (PE) of insulinomas and normal pancreas parenchyma were analyzed based on the MSCT data sets subsequently. RESULTS: Benign insulinoma was pathologically confirmed in 12 out of the 21 subjects, while the remaining 9 subjects were normal. Technical failures were experienced in 2 (9.5%) subjects. In both normal and tumor-suffered subjects (n = 19), perfusion parameters of normal pancreatic parachyma were measured as follows: BF (p) = 104. 9 +/- 28.9, pBV (p) = 166.4 +/- 41.8, TrP (p) = 133.3 +/- 24.4, Permeability (p) = 81.3 +/- 24.4, and peak enhancement (p) = 121.3 +/- 31.1. In subjects with insulinoma (n = 11), perfusion parameters of tumor tissue were measured as follows: F (i) = 206.5 +/- 42.2, BV (i) = 315.9 +/- 79.0, TFP (i) = 123.2 +/- 18.8, Permeability (i) = 102.5 +/- 54. 8, and peak enhancement (i) = 221.3 +/- 48.5. Results of F, BV, and peak enhancement in these two kinds of tissue showed significant differences (P < 0.01), while there were no significant difference (P > 0.05) in TTP and permeability between normal pancreatic parenchyma and insulinoma. CONCLUSIONS: Benign insulinoma has perfusion characteristics of increased blood flow and blood volume, but its TTP is consistent with normal pancreas and has normal permeability. MSCT allows further understanding of the blood flow of the normal pancreas and its benign tumor insulinoma.

[CT perfusion in evaluation of cerebral hemodynamics in carotid artery stenosis].

OBJECTIVE: To study the clinical value of multi-slice spiral CT (MSCT) perfusion technique in evaluation of cerebral hemodynamics in patients with severe carotid stenooclusive lesions. METHODS: Twenty-three patients with severe carotid stenosis were enrolled for evaluation of cerebral hemodynamics, including 12 patients with carotid occlusion and 11 with severe carotid stenosis (> 70%). Among them, 16 patients had multiple arterial diseases, including contralateral carotid stenosis, vertebral arteries stenosis, and cerebral arteries stenosis or occlusion. All patients received CT perfusion examination. Ten normal persons received CT perfusion were regarded as the control group. RESULTS: Cerebral perfusion was bilaterally symmetrical in 10 normal persons. While in the patients group, cerebral hemodynamic impairments ipsilateral to the stenosis side were found by CT perfusion in 17 patients, including an delay of time to peak (TTP) (17 patients), increase of cerebral blood volume (CBV) (7 patients), and decrease of cerebral blood flow (CBF) (4 patients). No significant difference was found between occlusion group (n = 8) and stenosis group (n = 9) (P = 0.640), but incidences of hemodynamic impairment were significantly higher in multiple arterial diseases group (n = 14) than single arterial disease group (n = 3) (P = 0.045). CONCLUSION: CT perfusion technique can sensitively reveal the cerebral hemodynamic impairments in patients with severe carotid stenooclusive diseases, and therefore valuable for clinical application.

[Diagnosis of Takayasu's arteritis affecting carotid arteries with multi-slice spiral CT].

OBJECTIVE: To explore changes in the carotid arteries in Tarkayasu arteritis (TA) with computed tomographic angiography (CTA). METHODS: The common carotid artery intima-medial thickness (CCA-IMT) in 20 common carotid arteries (CCAs) in 10 controls and 40 CCAs in 20 patients with TA were analyzed and compared. RESULTS: Contrast-enhanced CT scanning combined with the application of 3D reconstruction clearly showed the carotid vascular luminal abnormalities, such as stenosis, occlusion, dilation, and aneurysm formation. CCA-IMT increased in all the patients with TA affecting carotid arteries. CCA-IMT was significantly larger in the patients than in controls [(0.36 +/- 0.13) cm vs. (0.03 +/- 0.02) cm, P < 0.05] , and was significantly larger in patients with active diseases than in those without active diseases [(0.44 +/- 0.09) cm vs. (0.24 +/- 0.10) cm, P < 0.05]. CONCLUSION: CCA-IMT increases in TA affecting carotid arteries, especially in active diseases.