Can Bone Erosion in Axial Spondyloarthropathy be Detected by Ultrashort Echo Time Imaging? A Comparison With Computed Tomography in the Sacroiliac Joint.

BACKGROUND: Structural lesion evaluation in axial spondyloarthropathy (SpA) can improve accuracy of diagnosis. However, structural lesions (bone erosions) are difficult to be assessed using conventional MRI compared to computed tomography (CT). PURPOSE: To evaluate the diagnostic performance of ultrashort echo time (UTE) for detecting bone erosion in axial SpA compared to T1WI and three-dimensional double-echo steady-state (3D DESS) imaging using CT as the reference standard. STUDY TYPE: Retrospective. POPULATION: Fourteen patients (eight females, 57.1%) and 14 healthy controls (seven females, 50.0%) who underwent sacroiliac (SI) joint MRI and CT. FIELD STRENGTH/SEQUENCE: 3 T; TSE T1WI, 3D DESS, 2D UTE. ASSESSMENT: The bilateral SI joints were assessed for bone erosion. Three observers scored bone erosion for all three sequences of MRI. CT was used as the gold standard. Diagnostic confidence in axial SpA was measured based on a four-point confidence score. STATISTICAL TESTS: Correlation of erosion scores between CT and MRI were evaluated using Spearman's correlation test. Sensitivity, specificity, and positive-negative predictive values were calculated. Confidence scores were compared using the Wilcoxon sum rank test. Statistical significance was set at P < 0.05. RESULTS: Compared with erosion scores of CT, the correlation coefficients for each MRI sequence showed significant low-to-high positive correlations (0.39-0.72). UTE imaging showed the highest correlation coefficients for all observers (0.70, 0.72, and 0.67, respectively). The specificity of UTE imaging was equal or higher than those of T1WI and 3D DESS for all observers (0.86 vs. 0.71 vs. 0.57; 0.93 vs. 0.71 vs. 0.57; 0.79 vs. 0.79 vs. 0.43). All observers had the highest confidence in interpreting UTE imaging for detecting bone erosion among the three sequences (3.5, 3.4, and 3.3 for UTE; 3.1, 3.0, and 2.6 for T1WI; and 3.2, 2.7, and 2.4 for DESS). DATA CONCLUSION: UTE imaging can detect bone erosions in patients with axial SpA and show higher specificity than conventional T1WI and 3D DESS. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

CS-VIBE accelerates cranial nerve MR imaging for the diagnosis of facial neuritis: comparison of the diagnostic performance of post-contrast MPRAGE and CS-VIBE.

OBJECTIVE: We aimed to compare the diagnostic performance of post-contrast 3D compressed sensing volume-interpolated breath-hold examination (CS-VIBE) and 3D T1 magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) in detecting facial neuritis. MATERIALS AND METHODS: Between February 2019 and September 2019, 60 patients (30 facial palsy patients and 30 controls) who underwent contrast-enhanced cranial nerve MRI with both conventional MPRAGE and CS-VIBE (scan time: 6 min 8 s vs. 2 min 48 s) were included in this retrospective study. All images were independently reviewed by three radiologists for the presence of facial neuritis. In patients with facial palsy, signal-to-noise ratio (SNR) of the pons, enhancement degree and contrast-to-noise ratio (CNRnerve-CSF) of the facial nerve were measured. The overall image quality, artifacts, and facial nerve discrimination were analyzed. The sensitivity and specificity of both sequences were calculated with the clinical diagnosis as a reference. RESULTS: CS-VIBE had comparable performance in the detection of facial neuritis to that of MPRAGE (sensitivity and specificity, 97.8% and 99.4% vs. 100.0% and 99.4% in pooled analysis; 97.8% and 98.9% vs. 100.0% and 98.9% in patents with facial palsy, p value > 0.05 for all). CS-VIBE showed significantly lower SNR (p value < 0.001 for all), but significantly higher CNRnerve-CSF (p value < 0.05 for all) than MPRAGE. CS-VIBE also performed better in the overall image quality, artifacts, and facial nerve discrimination than MPRAGE (p value < 0.001 for all). CONCLUSION: CS-VIBE achieved comparable diagnostic performance for facial neuritis compared to the conventional MPRAGE, with the scan time being half of that of MPRAGE. KEY POINTS: • Post-contrast 3D CS-VIBE MRI is a reliable method for the diagnosis of facial neuritis. • CS-VIBE reduces the scan time of cranial nerve MRI by more than half compared to conventional T1-weighted image. • CS-VIBE had better performance in contrast-to-noise ratio and favorable image quality compared with conventional T1-weighted image.

Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula.

INTRODUCTION: This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. METHODS: Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. RESULTS: All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. CONCLUSION: NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage.

Weighted subtraction in 3D ultrashort echo time (UTE) imaging for visualization of short T2 tissues of the knee.

BACKGROUND: Ultrashort echo time (UTE) image to directly visualize short T2 tissues requires postprocessing for the suppression of the surrounding long T2 tissues in a clinical magnetic resonance imaging (MRI) scanner. Weighted subtraction of UTE images with an optimal weighting factor could provide high positive contrast with adequate suppression. PURPOSE: To demonstrate in-vivo UTE MRI with weighted subtractions of dual echo UTE imaging using a 3 T clinical MRI and to determine the optimal weighting factors through the analyses of signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs). MATERIAL AND METHODS: Forty-seven consecutive knee MR including dual echo 3D UTE sequence (TE of 70 µs and 3.82 ms) were reviewed. Seven patients with normal findings in the knee MR were included in the current study. For variably weighted subtraction images, the initial UTE image was rescaled relative to that of the second echo image with weighting factors from 0.1 to 4.0. Thirty-five pairs of the ROI measurements of the UTE image and second long echo images were repeated after 2 weeks. For quantitative assessment, SNR and CNR were measured from the ROIs on the patellar tendon, cartilage, cortical bone, meniscus, and infrapatellar fat pad. Intra-observer agreement was assessed by using both Cohen's Kappa and Bland-Altman approach. RESULTS: The short T2 tissue could be visualized with adequate suppression on the subtraction images. Considering the CNRs and SNRs, the optimal ranges of the weighting factors could be suggested: 0.3 for the tendon, 0.4 for the cortical bone, and 1.0 for the meniscus. The 35 paired measurements showed excellent agreement with statistical significance (P < 0.05). CONCLUSION: The 3D UTE MRI provides imaging of short T2 tissues which cannot be visualized by conventional MRI. Using weighted subtractions with optimal weighting values, each tissue can be optimally depicted by overcoming the reduced T2 contrast.

Information and Communication Technology-Based Application for Cognitive Behavioral Therapy among Community-Dwelling Older Adults with Insomnia: Development and Validation Study.

This study developed an information and communication technology-based mobile application to administer cognitive behavioral therapy to community-dwelling older adults with insomnia. First, the content of the application was determined through a systematic review and preference survey. Preference data on the perception, needs, and preference for non-face-to-face service content were collected from 15 July 2021 to 31 August 2021 from 100 community-dwelling older adults aged 65 years and older. In the design stage, the structure and function of the application were determined, and an interface was designed. The application was developed in conjunction with design experts and programmers using Android Studio software (Android 9). Usability tests were conducted during the implementation stage, followed by an evaluation stage. The evaluation revealed that the application's structure and functions should comprise sleep information, sleep-habit improvement, sleep assistance, video, real-time counseling, and exercise services. These elements were finalized after receiving the results of a preference analysis and advice from an advisory panel of experts in different fields. The developed application was rated with a score of four or higher in all areas. This study successfully developed, implemented, and evaluated a new mobile application called Smart Sleep for community-dwelling older adults with insomnia.

Deep learning image reconstruction of diffusion-weighted imaging in evaluation of prostate cancer focusing on its clinical implications.

Background: Image-based assessment of prostate cancer (PCa) is increasingly emphasized in the diagnostic workflow for selecting biopsy targets and possibly predicting clinically significant prostate cancer (csPCa). Assessment is based on Prostate Imaging-Reporting and Data System (PI-RADS) which is largely dependent on T2-weighted image (T2WI) and diffusion weighted image (DWI). This study aims to determine whether deep learning reconstruction (DLR) can improve the image quality of DWI and affect the assessment of PI-RADS ≥4 in patients with PCa. Methods: In this retrospective study, 3.0T post-biopsy prostate magnetic resonance imaging (MRI) of 70 patients with PCa in Korea University Ansan Hospital from November 2021 to July 2022 was reconstructed with and without using DLR. Four DWI image sets were made: (I) conventional DWI (CDWI): DWI with acceleration factor 2 and conventional parallel imaging reconstruction, (II) DL1: DWI with acceleration factor 2 using DLR, (III) DL2: DWI with acceleration factor 3 using DLR, and (IV) DL3: DWI with acceleration factor 3 and half average b-value using DLR. Apparent diffusion coefficient (ADC) value, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured by one reviewer, while two reviewers independently assessed overall image quality, noise, and lesion conspicuity using a four-point visual scoring system from each DWI image set. Two reviewers also performed PI-RADSv2.1 scoring on lesions suspected of malignancy. Results: A total of 70 patients (mean age, 70.8±9.7 years) were analyzed. The image acquisition time was 4:46 min for CDWI and DL1, 3:40 min for DL2, and 2:00 min for DL3. DL1 and DL2 images resulted in better lesion conspicuity compared to CDWI images assessed by both readers (P<0.05). DLR resulted in a significant increase in SNR, from 38.4±14.7 in CDWI to 56.9±21.0 in DL1. CNR increased from 25.1±11.5 in CDWI to 43.1±17.8 in DL1 (P<0.001). PI-RADS v2.1 scoring for PCa lesions was more agreeable with the DL1 reconstruction method than with CDWI (κ value CDWI, DL1; 0.40, 0.61, respectively). A statistically significant number of lesions were upgraded from PI-RADS <4 in CDWI image to PI-RADS ≥4 in DL1 images for both readers (P<0.05). Most of the PI-RADS upgraded lesions were from higher than unfavorable intermediate-risk groups according to the 2023 National Comprehensive Cancer Network guidelines with statistically significant difference of marginal probability in DL1 and DL2 for both readers (P<0.05). Conclusions: DLR in DWI for PCa can provide options for improving image quality with a significant impact on PI-RADS evaluation or about a 23% reduction in acquisition time without compromising image quality.

Deep Learning-Based Synthetic TOF-MRA Generation Using Time-Resolved MRA in Fast Stroke Imaging.

BACKGROUND AND PURPOSE: Time-resolved MRA enables collateral evaluation in acute ischemic stroke with large-vessel occlusion; however, a low SNR and spatial resolution impede the diagnosis of vascular occlusion. We developed a CycleGAN-based deep learning model to generate high-resolution synthetic TOF-MRA images using time-resolved MRA and evaluated its image quality and clinical efficacy. MATERIALS AND METHODS: This retrospective, single-center study included 397 patients who underwent both TOF- and time-resolved MRA between April 2021 and January 2022. Patients were divided into 2 groups for model development and image-quality validation. Image quality was evaluated qualitatively and quantitatively with 3 sequences. A multireader diagnostic optimality evaluation was performed by 16 radiologists. For clinical validation, we evaluated 123 patients who underwent fast stroke MR imaging to assess acute ischemic stroke. The diagnostic confidence level and decision time for large-vessel occlusion were also evaluated. RESULTS: Median values of overall image quality, noise, sharpness, venous contamination, and SNR for M1, M2, the basilar artery, and posterior cerebral artery are better with synthetic TOF than with time-resolved MRA. However, with respect to real TOF, synthetic TOF presents worse median values of overall image quality, sharpness, vascular conspicuity, and SNR for M3, the basilar artery, and the posterior cerebral artery. During the multireader evaluation, radiologists could not discriminate synthetic TOF images from TOF images. During clinical validation, both readers demonstrated increases in diagnostic confidence levels and decreases in decision time. CONCLUSIONS: A CycleGAN-based deep learning model was developed to generate synthetic TOF from time-resolved MRA. Synthetic TOF can potentially assist in the detection of large-vessel occlusion in stroke centers using time-resolved MRA.

Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation.

PURPOSE: To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI. MATERIALS AND METHODS: Institutional Review Board approval and written informed consent were obtained. Ninety-two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child-Pugh class A and 15 Child-Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using three-dimensional spoiled gradient echo sequences with two different flip angles (2° and 14°) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child-Pugh class A, and Child-Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t-test for each group. RESULTS: The baseline liver T1 value was significantly higher in the control group (941 ± 136 ms) than in Child-Pugh A (858 ± 143 ms) and Child-Pugh B/C (783 ± 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P = 0.012) but not significant in Child-Pugh class A (P = 0.079) and Child-Pugh class B/C (P = 0.752). CONCLUSION: The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients.

Usefulness of 3D High-resolution Vessel Wall MRI in Diffuse Nonaneurysmal SAH Patients.

PURPOSE: In 15-20% of patients with nontraumatic diffuse subarachnoid hemorrhage (SAH), the initial conventional angiography does not reveal a causative vascular abnormality, such as intracranial aneurysm. In this study, we evaluated clinical utility of 3D high-resolution vessel wall magnetic resonance imaging (HR-VWI) in patients with diffuse nonaneurysmal SAH. METHODS: A total of 17 patients with diffuse nonaneurysmal SAH were included in this retrospective study. We characterized demographics and HR-VWI findings and reviewed the clinical management and outcomes. RESULTS: Of the patients 14 (14/17; 82.4%,) showed abnormal findings on HR-VWI, including 5 with intracranial dissections (29.4%), 3 with blood blister-like aneurysm (17.6%), 1 with ruptured fusiform aneurysm (5.9%), and 5 with focal nodular wall enhancement without unclassified pathology (29.4%). Of these patients were treated with endovascular management. Most patients (16/17) had a favorable modified Rankin scale scores of 0-2 on discharge. CONCLUSION: The 3D HR-VWI revealed various hidden pathologies, such as intracranial arterial dissection, blood blister-like aneurysm, and fusiform aneurysm in patients with diffuse nonaneurysmal SAH. In addition, 3D HR-VWI had an impact on the management of SAH. The 3D HR-VWI can be a complementary diagnostic method for patients with diffuse nonaneurysmal SAH in a research or clinical setting.

Compressed sensing time-of-flight magnetic resonance angiography with high spatial resolution for evaluating intracranial aneurysms: comparison with digital subtraction angiography.

BACKGROUND AND PURPOSE: Compressed sensing is used for accelerated acquisitions with incoherently under-sampled k-space data, and intracranial time-of-flight magnetic resonance angiography is suitable for compressed sensing. Compressed sensing time-of-flight is beneficial in decreasing acquisition time and increasing spatial resolution while maintaining acquisition time. In this retrospective study, we aimed to evaluate the image quality and diagnostic performance of compressed sensing time-of-flight with high spatial resolution and compare with parallel imaging time-of-flight using digital subtraction angiography as a reference. MATERIAL AND METHODS: In total, 39 patients with 46 intracranial aneurysms underwent parallel imaging and compressed sensing time-of-flight in the same imaging session and digital subtraction angiography before or after magnetic resonance angiography. The overall image quality, artefacts and diagnostic confidence were assessed by two observers. The contrast ratio, maximal aneurysm diameters and diagnostic performance were evaluated. RESULTS: Compressed sensing time-of-flight showed significantly better overall image quality, degree of artefacts and diagnostic confidence in both observers, with better inter-observer agreement. The contrast ratio was significantly higher for compressed sensing time-of-flight than for parallel imaging time-of-flight in both observers (source images, P < 0.001; maximum intensity projection images, P < 0.05 for both observers); however, the measured maximal diameters of aneurysms were not significantly different. Compressed sensing time-of-flight showed higher sensitivity, specificity, accuracy and positive and negative predictive values for detecting aneurysms than parallel imaging time-of-flight in both observers, with better inter-observer agreement. Compressed sensing time-of-flight was preferred over parallel imaging time-of-flight by both observers; however, parallel imaging time-of-flight was preferred in cases of giant and large aneurysms. CONCLUSIONS: Compressed sensing-time-of-flight provides better image quality and diagnostic performance than parallel imaging time-of-flight. However, neuroradiologists should be aware of under-sampling artefacts caused by compressed sensing.

Resting-state functional connectivity in medication-naïve adolescents with major depressive disorder.

Adolescence is a vulnerable period for major depressive disorder (MDD). The aim of our study was to investigate resting-state functional connectivity (RSFC) in first-episode, medication-naïve adolescent MDD patients. Twenty-three drug-naïve adolescents diagnosed with first-episode MDD and 27 healthy participants were enrolled. Seed-to-voxel RSFC analyses were performed. The frontolimbic circuit regions of interest included the amygdala, anterior cingulate cortex, insula, and hippocampus. A correlation analysis between the RSFC and Children's Depression Inventory, Hamilton depression rating scale, and duration of episodes was performed. The adolescents with MDD exhibited the following characteristics: a lower RSFC between the right amygdala and right superior frontal gyrus; a lower RSFC between the right hippocampus and clusters including the right insula and right middle frontal gyrus; a higher RSFC between the left insula and clusters including the bilateral middle frontal gyrus, right superior frontal gyrus, and right frontal pole; and a higher RSFC between the left dorsal anterior cingulate cortex and a cluster including the left insula. Medication-naïve adolescents with depression display lower connectivity of several brain regions implicated in processing, regulation, and memory of emotions. Higher connectivity was observed in brain regions that potentially explain rumination, impaired concentration, and physiological arousal.

Intravoxel incoherent motion diffusion-weighted MR imaging for differentiation of benign and malignant musculoskeletal tumours at 3 T.

OBJECTIVE: To evaluate the intravoxel incoherent motion (IVIM) diffusion-weighted (DW) MRI for differentiating between benign and malignant musculoskeletal tumours at 3 T. METHODS: 65 patients with treatment-naïve musculoskeletal tumours (47 malignant and 23 benign lesions) who underwent 3 T MRI including IVIM DW imaging were included. IVIM-derived parameters included pure diffusion coefficient (D), perfusion related incoherent microcirculation (D*, pseudodiffusion coefficient), and perfusion fraction (f). IVIM parameters and mono-exponential apparent diffusion coefficient (ADC) were retrospectively measured by two independent musculoskeletal radiologists. RESULTS: D and ADC values of malignant tumours (923 ± 360, 965 ± 353 µm2 s-1, respectively) were significantly lower than those of benign tumours (1668 ± 546, 1689 ± 526 µm2 s-1) (p < 0.001). F values of malignant tumours (9.6%) were significantly higher than those of benign tumours (7.2%) (p = 0.021), whereas D* values showed no significant difference (p > 0.05). The area under the receiver operating characteristic (ROC) curve of D, ADC and f were 0.874, 0.880 and 0.671, respectively. Using cut-off values of D and ADC of 1200 µm2 s-1, the sensitivity, specificity and accuracy were 92, 83, 89%, 92, 87 and 90%, respectively. CONCLUSION: D and ADC may be more accurate and reliable for differentiation of malignant from benign musculoskeletal tumours than f and D* at 3 T IVIM DW imaging. Advances in knowledge: Among IVIM-derived parameters, D is more accurate and reliable in differentiating malignant from benign musculoskeletal tumours than f and D* at 3.0T IVIM DW imaging. There was no significant difference in the diagnostic performance of D and ADC.

Increased urinary level of oxidized nucleosides in patients with mild-to-moderate Alzheimer's disease.

OBJECTIVE: Oxidative stress may play an important role in the pathogenesis of Alzheimer's disease (AD). DESIGN AND METHODS: To investigate the possible role of oxidative DNA damage in the pathogenesis of AD, we measured the metabolite concentrations of oxidized nucleosides (pseudouridine, 1-methyladenosine, 5-methylcytidine, 5-methyl-2'-deoxycytidine, 3-methyluridine, N(2), N(2)-dimethylguanosine, 8-hydroxy-2'-deoxyguanosine, 5-deoxyadenosine and 2-deoxyguanosine) in urine between AD (n=36) and control subjects (n=34) using liquid chromatography-mass spectrometry (LC-MS) without urine preparation. RESULTS: In AD, the 3-methyluridine, 1-methyladenosine, 8-hydroxy-2'-deoxyguanosine (p<0.05, respectively), 2-deoxyguanosine (p<0.01) and pseudouridine, N(2), N(2)-dimethylguanosine (p<0.001, respectively) were significantly increased when compared with the control subjects. CONCLUSION: The results indicate that oxidized urinary nucleosides may be useful as biomarkers for AD in early stages.

Increased urinary F(2)-isoprostanes levels in the patients with Alzheimer's disease.

Isoprostanes, novel markers of oxidative injury, are generated by the free radical-mediated peroxidation of arachidonic acid (AA). They are thought to be important in the pathogenesis of neurodegenerative diseases such as Alzheimer's disease (AD). Using gas chromatography-mass spectrometry (GC-MS), we investigated the alteration of urinary F(2)-isoprostanes in AD patients compared to that of healthy subjects. Our results show that the levels of urinary F(2)-isoprostanes, sum of the prostaglandin F(2 alpha) isomer; prostaglandin F(2 alpha) (PGF(2 alpha)), prostaglandin F(2 beta) (PGF(2 beta)), and 8-isoprostaglandin F(2 alpha) (8-isoPGF(2 alpha)), significantly increased in AD patients (P < 0.05). The concentration of urinary 8-isoPGF(2 alpha), one of the biomarkers of oxidative stress, was not significantly different between 34 AD patients and 20 age-matched controls (P > 0.05). The PGF(2 alpha), formed by endoperoxide reductase from PGH(2), was significantly increased in AD patients, when compared with the levels of the normal controls (P < 0.05). The PGF(2 alpha), an enzymatic product of arachidonic acid, may affect the pathogenesis of AD. In addition, urinary F(2)-isoprostanes can play an important role as a biomarker in AD.

¹8F-FDG PET metabolic parameters and MRI perfusion and diffusion parameters in hepatocellular carcinoma: a preliminary study.

OBJECTIVES: Glucose metabolism, perfusion, and water diffusion may have a relationship or affect each other in the same tumor. The understanding of their relationship could expand the knowledge of tumor characteristics and contribute to the field of oncologic imaging. The purpose of this study was to evaluate the relationships between metabolism, vasculature and cellularity of advanced hepatocellular carcinoma (HCC), using multimodality imaging such as ¹8F-FDG positron emission tomography (PET), dynamic contrast enhanced (DCE)-MRI, and diffusion weighted imaging(DWI). MATERIALS AND METHODS: Twenty-one patients with advanced HCC underwent ¹8F-FDG PET, DCE-MRI, and DWI before treatment. Maximum standard uptake values (SUV(max)) from ¹8F-FDG-PET, variables of the volume transfer constant (K(trans)) from DCE-MRI and apparent diffusion coefficient (ADC) from DWI were obtained for the tumor and their relationships were examined by Spearman's correlation analysis. The influence of portal vein thrombosis on SUV(max) and variables of K(trans) and ADC was evaluated by Mann-Whitney test. RESULTS: SUV(max) showed significant negative correlation with K(trans)(max) (ρ = -0.622, p = 0.002). However, variables of ADC showed no relationship with variables of K(trans) or SUV(max) (p>0.05). Whether portal vein thrombosis was present or not did not influence the SUV max and variables of ADC and K(trans) (p>0.05). CONCLUSION: In this study, SUV was shown to be correlated with K(trans) in advanced HCCs; the higher the glucose metabolism a tumor had, the lower the perfusion it had, which might help in guiding target therapy.

Effect of the COMT val158met polymorphism on white matter connectivity in patients with major depressive disorder.

Cortico-limbic network dysfunction and genetic polymorphism are considered to be associated with major depressive disorder (MDD). Using diffusion tensor imaging (DTI), we investigated the relationship between catechol-O-methyltransferase (COMT) gene polymorphisms and white matter tract integrity in patients with MDD. Eighty-six patients with MDD and 62 healthy controls participated in this study. DTI and genotyping for the COMT val158met gene (rs4680) polymorphism were conducted to determine the impact of COMT polymorphisms on white matter changes in patients with MDD. Voxel-wise statistical analyses of fractional anisotropy (FA) were performed using tract-based spatial statistics (TBSS). FAs of the MDD patient group were significantly decreased in bilateral frontal forceps minor, bilateral anterior cingulum, genu of corpus callosum, left posterior cingulum, right superior longitudinal fasciculus, and right posterior thalamic radiation compared with those of healthy controls. In the MDD patient group, mean FA in subjects with the GG allele was significantly decreased in left inferior longitudinal fasciculus, bilateral middle temporal gyrus, right frontal gyrus, and right cingulum bundle area compared with subjects with the AA/AG allele. These findings suggest cortico-limbic network dysfunction in MDD. Specifically, further FA reduction was evident in MDD patients with the valine homozygote group of the COMT gene. MDD may be associated with dysfunctional white matter changes, and the valine homozygote of COMT gene may contribute to further abnormalities in these pathological changes.

Severe edema of the eyes and lips as rare side effects of eye ointment for protection of eyes under general anesthesia -A case report-.

Patients undergoing non-ocular surgery under general anesthesia may suffer from ocular complications because of the loss of protective reflexes. Simple taping of the eyelids closed, the instillation of ointments into the conjunctival sac, and the use of protective goggles have been recommended for eye protection. We observed a case of a 6-year-old child undergoing tonsillectomy and adenoidectomy who experienced severe edema after application of an ointment (Terramycin ophthalmic ointment) to the orbits and upper lip. After several days of steroid and antihistamine administration, the edema of the orbits and lip returned to normal. Therefore, we suggest that unexpected edema in the orbits and lip following surgery can be due to hypersensitivity to the ointment.

Airway obstruction after biopsy by cervical mediastinoscopy in a patient with a mediastinal mass -A case report-.

Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression.

Automated hippocampal subfields segmentation in late life depression.

Although a few automated hippocampal subfields segmentation methods have been developed, there has been no in vivo Magnetic Resonance Imaging (MRI) study on the hippocampal subfields volumes of Late Life Depression (LLD). The aim of this study was to investigate the hippocampal subfields volume differences between LLD subjects and healthy elderly controls using an automated hippocampal subfields segmentation technique. Thirty subjects with LLD and 30 group-matched healthy control subjects underwent 3T MRI scanning, and hippocampal subfields volumes were measured and compared between the groups. Subjects with LLD exhibited significant hippocampal volume reductions in the total hippocampus, subiculum, and Cornu Ammonis (CA) 2-3 areas compared with healthy subjects (uncorrected, p<0.001). This study is the first to elaborate the subfields volume differences of both hippocampi between controls and LLD patients. These structural changes in the hippocampal presubiculum, subiculum, and CA2-3 areas might be at the core of the underlying neurobiological mechanisms of hippocampal dysfunction in LLD.

Relationships between hippocampal shape and cognitive performances in drug-naïve patients with Alzheimer's disease.

Previous studies provided hippocampal shape analysis of Alzheimer's disease (AD) patients using automated segmentation techniques. However, the relationships between the hippocampal deformations and various cognitive impairments were not clear. The aim of this study was to investigate hippocampal shape changes and their relationship to cognitive impairments. Fifty-one drug-naïve patients with AD and 50 group-matched healthy control subjects underwent 3T MRI scanning, and the hippocampal volumes and deformations were compared between the groups. Additionally, we explored the correlation pattern between the hippocampal deformations and the cognitive dysfunctions in AD using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K). AD subjects exhibited significant hippocampal deformations in the cornu ammnonis (CA1) and subiculum areas compared to those in healthy subjects (p<0.05, false discovery rate (FDR) corrected). Significant correlations were observed between hippocampal deformations in CA1 and subiculum areas and verbal immediate recall, verbal delayed recall, verbal recognition memory, and constructional recall scores (p<0.05, FDR corrected). This study was the first to explore the relationships between hippocampal deformations and various cognitive impairments of drug-naïve patients with AD. These structural changes in hippocampal CA1 and subiculum areas might be the core of the underlying neurobiological mechanisms of hippocampal dysfunction and their relevance to the various cognitive dysfunctions in AD.